Q Which CPT and ICD-9 codes should we use for the reversal of a ritual circumcision, i.e., female genital mutilation?
A First, report any symptoms or scarring the patient has. For example, possible codes include 623.2 (stricture or atresia of the vagina), 624.4 (old laceration or scarring of the vulva), or 624.8 (other specified noninflammatory disorders of the vulva and perineum). (The code V50.2 [routine or ritual circumcision] is inappropriate as it applies to male circumcision only.)
For the surgery itself, the repair codes are best because the physician first creates the defect (incision) and then repairs it. Look at codes 12001 to 12007, 12041 to 12047, and 13131 to 13133, or consider 56800 (plastic repair of the introitus) if more extensive repair work was performed. If there are labial adhesions, use the code 56441. The code 58999 can be used as a backup, as circumcision reversal may truly be an unlisted procedure. Always submit documentation with the claim.
This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.