Reimbursement Advisor

Excised lesions are coded by diameter

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Q Would the excision of a single lesion for a diagnosis of VIN III be excision of a malignant lesion?

A No. A diagnosis of VIN III means that the patient has an intraepithelial neoplasia, and the diagnostic code would be 233.3, carcinoma in situ of the vulva. However, VIN III leads to invasive cancer in only about 4% of women, so this condition is considered preinvasive, not cancerous.

Unless the physician has indicated in the operative note that a simple partial vulvectomy was performed (eg, with more extensive lesions), I would pick codes that represent a benign or premalignant lesion.

If the lesion was excised, the code choice would be one of 11420 through 11426 (excision, benign lesion including margins, except skin tags [unless listed elsewhere], scalp, neck, hands, feet, genitalia; excised diameter […]). Each code in this series specifies a different lesion diameter (≤0.5 cm up to >4.0 cm); you would select the code based on the greatest clinical diameter of the lesion plus the margin required for complete excision.

If the lesion was destroyed, the code 56501 (destruction of lesion[s], vulva; simple) or 56515 (destruction of lesion[s], vulva; extensive) would be reported instead.

Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects 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.

OBG Management ©2005 Dowden Health Media

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