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ASC Coding: Female Genital Reproductive System

By Paul Cadorette, CPC, COC, CPC-P, COSC, CASCC, Director of Education, nimble solutions
The Anatomy of Coding: Female Genital/Reproductive System, is available on demand. click here to take this course.

ASC coders looking to master coding for the female genital reproductive system require a solid grasp of various procedures.  

Here’s a list of the most common procedures and how they’re defined. I’ll review the CPT codes for these procedures as well as recent coding changes in the 2024 female genital reproductive system coding course. 

Loop Electrode Biopsy vs. Loop Electrode Conization 

It’s crucial to differentiate between a loop electrode biopsy and a loop electrode conization. The cervix can develop lesions on the ecto/exocervix (outside the cervical canal).  

A loop electrode biopsy involves sampling a lesion that does not include the endocervix (inside the cervical canal). In contrast, a conization procedure removes a portion of both the ecto/exocervix and the endocervix, resulting in a cone-shaped specimen, hence the term “conization.” 

Understanding Colporrhaphy Procedures

When coding for colporrhaphy procedures, be aware there are different CPT codes for individual and combined services.  

Choosing the right codes requires specific knowledge of the specific conditions and treatments, including: 

  • Anterior Colporrhaphy: Suturing of the anterior vaginal wall to treat a cystocele. 
  • Posterior Colporrhaphy: Suturing of the posterior vaginal wall to treat a rectocele. 
  • Combined Anteroposterior Colporrhaphy: Repairing both a cystocele and rectocele during the same surgical session. 
  • Anteroposterior Colporrhaphy with Enterocele Treatment: Repairing a cystocele and rectocele along with treating an enterocele, a herniation of the small intestine into the rectovaginal septum behind the cervix. 

In addition to CPT codes for colporrhaphy procedures, there is an add-on code for mesh insertion to strengthen the repair. This mesh code can be reported up to two times if mesh is inserted in both the anterior and posterior compartments. 

Total Laparoscopic Hysterectomy vs. Laparoscopic Vaginal Hysterectomy

  • Total Laparoscopic Hysterectomy: The scope is inserted, and all supporting structures are released. The uterus (with or without tubes and/or ovaries) is then removed either through the abdomen or the vagina. The removal method does not change this to a vaginal hysterectomy. 
     
  • Laparoscopic Vaginal Hysterectomy: The scope is inserted into the abdomen, and only the upper supporting structures are released. The physician then approaches through the vagina to release the lower supporting structures, removing the uterus (with or without tubes and/or ovaries) through the vagina. This technique qualifies as a vaginal hysterectomy. 

Modifier -50 for CPT Code 58661 

The guidance on appending modifier -50 to CPT code 58661 (Laparoscopy, surgical; with removal of adnexal structures [partial or total] oophorectomy and/or salpingectomy) has fluctuated over the years.

The 2024 CPT Manual now includes a parenthetical note clarifying that for a bilateral procedure, you should report 58661 with modifier -50.

ASC Coding Tips: Female Genital Reproductive System

These are just a few of the valuable coding tips featured in our coding course on the Female Genital Reproductive System.

Click here to enhance your expertise and receive CEUs from AAPC by completing this coding course.