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Keeping up with CPT 2003

OBG Manag. 2003 January;15(1):36-43

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(For cervicography, see Category III code 0003T.)

57452 Colposcopy of the cervix including upper/adjacent vagina;
57454 with biopsy(s) of the cervix and endocervical curettage
57455 with biopsy(s) of the cervix
57456 with endocervical curettage
57460 with loop electrode biopsy(s) of the cervix
57461 with loop electrode conization of the cervix

Coders should note the following guidelines:

If colposcopy is performed on both the vagina and vulva, both procedures may be reported, with modifier -51 added to the code of lesser relative value.
A superficial cervical examination is considered part of a complete vaginal examination (codes 57420 and 57421), if performed.
If the main purpose of the examination is to evaluate the cervix, not the vagina, only the cervical colposcopy codes (54452-57461) would be reported.
Colposcopy of the cervix codes (54452-57461) include an examination of the entire cervix as well as the upper/adjacent portion of the vagina.
Code 57460 has been revised and code 57461 added to clarify the 2 different cervical loop electrode excision procedures that might be done in conjunction with colposcopy. Code 57460 includes removal of the exocervix and a portion of the transformation zone, if necessary. Code 57461 represents a conization procedure that takes all of the exocervix, the transformation zone, and some or all of the endocervix.
An endocervical curettage is included as part of a conization; therefore code 57456 would not be reported in addition to code 57461.

Bladder procedures, incontinence testing

Three new codes were developed to replace HCPCS code G0002 (office procedure, insertion of temporary indwelling catheter, Foley type [separate procedure]). These would be reported only when the catheter insertion is an independent procedure, not part of another procedure.

Codes 53670 and 53675 (both catheterization procedures listed under the heading “urethra”) have been deleted. In their place are new codes that are more appropriate.

51701 Insertion of non-indwelling bladder catheter (e.g., straight catheterization for residual urine)
51702 Insertion of temporary indwelling bladder catheter; simple (e.g., Foley)
51703 complicated (e.g., altered anatomy, fractured catheter/balloon)

Urodynamics. Code 51798 (measurement of postvoiding residual urine and/or bladder capacity by ultrasound, nonimaging) replaces code 78730, which had been inaccurately placed in CPT’s nuclear medicine section, as well as the HCPCS Level II G code G0050 (measurement of postvoiding residual urine and/or bladder capacity by ultrasound, nonimaging). The new code represents a more accurate description of this noninvasive procedure, which uses a handheld Doppler ultrasonic device. This code represents only the technical component of the procedure, and is not associated with physician work that involves interpretation because the device gives a numeric result.

Abdominal procedures

49419 Insertion of intraperitoneal cannula or catheter, with subcutaneous reservoir, permanent (i.e., totally implantable)

This would be reported by gynecologic oncologists who want to provide intraperitoneal chemotherapy in women with ovarian or primary peritoneal cancer. The procedure requires an incision and the creation of a pocket for the reservoir.

For the removal of these devices, use code 49422.

Blood collection

36415 Collection of venous blood by venipuncture
36416 Collection of capillary blood specimen (e.g., finger, heel, ear stick)

Code 36415 was revised and code 36416 was added to better assign blood collection methods, and so that HCPCS Temporary G code G0001—routine venipuncture for collection of specimen(s)—could be deleted.

Excising skin lesions

Coders now choose which skin-lesion code to report based on the total amount of tissue removed at the site during the operative session, not just lesion size. These codes were revised so it’s clear they describe a full-thickness removal of the lesion, including the margin, along with simple closure (if performed).

11420 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less
11421 excised diameter 0.6 to 1.0 cm
11422 excised diameter 1.1 to 2.0 cm
11423 excised diameter 2.1 to 3.0 cm
11424 excised diameter 3.1 to 4.0 cm
11426 excised diameter over 4.0 cm
11620 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less
11621 excised diameter 0.6 to 1.0 cm
11622 excised diameter 1.1 to 2.0 cm
11623 excised diameter 2.1 to 3.0 cm
11624 excised diameter 3.1 to 4.0 cm
11626 excised diameter over 4.0 cm

Coding for new technology

Category III codes represent emerging technology, and several that may be of use to Ob/Gyns have been added. Note that payers may not yet reimburse for these procedures. These procedure codes are listed in the CPT book just prior to Appendix A.

When a Category III code accurately describes the procedure or service performed, use that code rather than an unlisted code. CPT adds Category III codes to its database in January and July. To check on any Category III code updates, go to www.amaassn.org/ama/pub/article/3885-4897.html:

Keeping up with CPT 2003

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