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In a particular scenario, my ob-gyn documented the following procedure: Excision granulation tissue vaginal cuff. Laparoscopy, extensive lysis of adhesions of the sigmoid colon to posterior cul-de-sac. Scissors utilized to cut it; Uterosacral stitch out of peritoneum. Exam pointed to connection of the granulation tissue through the vagina into peritoneum. All granulation tissue was removed from vagina as well as inflammation and what seemed like reaction to stitch. How should you code this particular scenario? Well, you should report the lysis of adhesions with 44180 and the removal of the granulation from the vaginal cuff (carried out vaginally) as 58999 (Unlisted procedure, female genital system [nonobstetrical]). While reporting an unlisted procedure code, you need to let the payer know how to judge that your charge is reasonable based on the physician work. Better still: Check with your surgeon to see what procedure he would like to compare this work to in order to set your fee. You should also let the payer know an equivalent of the estimated amount of work. In order to do this, review your doctor's to note how the ob-gyn removed the granulation tissue. You might compare the work to 17250 if done by chemical cautery. If done by destruction, say for instance using a laser, by cryocautery you might compare the work to 57061 or 57065. If he debrided the area, you might use 11042, and if he excised the tissue, you would need to know the extent of the area removed and look to 11440-11446 as a comparison since the vaginal canal would be consistent with a mucus membrane. While trying to code for the stitch removal, don't bother as this service seems to be part of the adhesions involvement. For more on this and for other specialty specific articles to assist your ob-gyn coding, sign up for a good medical coding resource like Coding Institute.
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