Removing a lesion or taking cervical biopsies may seem like a simple procedure. However, gynecologists often question themselves when billing for the services. One common code for these procedures is CPT code 57500.
However, it comes with its fair share of confusion, like: Should you bill multiple units for taking different biopsies? Is fulguration bundled into it? Etc.
We will discuss everything from the code descriptor to clinical scenarios, applicable modifiers, and reimbursement guidelines. Simply put, this guide will answer every question that comes to your mind. So, continue reading!
CPT Code 57500 – Description
CPT code 57500 covers lesion removal, such as a polyp on the cervix or a single/multiple cervical biopsies with or without fulguration.
For the unversed, fulguration is a technique that utilizes high-frequency electric current to destroy tissue.
A Scenario Where CPT Code 57500 is Applicable
Let’s review a real-world clinical scenario to understand where CPT 57500 applies:
Symptomatic Cervical Polyp Removal
Consider a 42-year-old female patient who comes to the OBGYN clinic with persistent intermenstrual bleeding. The gynecologist performs a physical examination and notes a large, easily bleeding cervical polyp.
As a result, the gynecologist removes the polyp using a specialized instrument. Moreover, he uses fulguration to seal the remaining stump and control hemorrhage.
Here, CPT code 57500 applies.
Applicable Modifiers for CPT Code 57500
Don’t know what to do when performing multiple procedures in the same session? Listed below is an applicable modifier for CPT 57500 that will save you from upcoding:
Modifier 51
What happens when you perform multiple procedures during the same encounter? You append modifier 51 to indicate that you expect 100% payment for the primary service and 50% payment for the secondary procedure.
Assume a physician performs a dilation and curettage (D&C) covered under 58120 for a 48-year-old patient experiencing heavy menstrual bleeding. During the procedure, the physician notes a suspicious lesion on the cervix and decides to take a biopsy (CPT code 57500). Here, modifier 51 is applicable to ensure accurate reimbursement for both services.
CPT Code 57500 – Billing & Reimbursement Guidelines
Discussed below are the essential billing guidelines related to CPT 57500:
Ensure the Correct Use of 57500
CPT code 57500 (cervical biopsy) is bundled into a more comprehensive code 57454 (Colposcopy of the cervix with biopsy). According to the NCCI edits, these two services cannot be unbundled and overridden with a modifier. So, if the colposcopy and biopsy were performed in the same session, you must report the more comprehensive code 57454 instead of reporting the biopsy as a standalone service.
Justify Medical Necessity
Regardless of the insurance plan the patient is enrolled in, you are required to justify that the removal of a lesion on the cervix or biopsy (CPT code 57500) was medically necessary. Therefore, you should:
- Attach a signed, dated physician order requesting the service.
- Explain the specific clinical reason for biopsy or lesion removal with the appropriate ICD-10-CM code.
Examples: N84.1 (visible cervical lesion/polyp), or N93.9 (abnormal uterine and vaginal bleeding), etc.
- Add copies or references to the supporting lab/pathology tests mandating the service.
Fulfill Documentation Requirements
Here’s what you should include in your documentation while billing for CPT code 57500:
- Mention the date of service.
- Confirm the approach, i.e., did the physician perform the procedure with fulguration or conduct it in an office setting?
- Explicitly state the rendered service, e.g., targeted cervical biopsy, or polyp removal, etc.
- State the exact numbers and locations of biopsies.
- Describe how the physician controlled the bleeding.
Example: The physician performed fulguration.
- Explain how you handled the collected specimens. For instance, you sent two labeled specimens for pathology examination, etc.
Review Payer-Specific Policies
Payer policies for reimbursing CPT code 57500 may vary significantly. Thus, we advise establishing open lines of communication with the payer and understanding their specific rules before submitting the medical claim. It is a billing best practice that will help you ensure compliance and prevent audit risks.
Summary
We know that CPT code 57500 covers lesion removal on the cervix or cervical biopsies (single or multiple) with/without fulguration.
However, if you conduct multiple procedures during the same session, e.g., D&C and biopsies, you should append modifier 51. Not using it may result in overpayment, denials, or audit risks.
We also listed the documentation requirements for this procedural code.
Hopefully, this guide will serve as a go-to resource when billing for cervical biopsies or lesion removal. However, if you still struggle, feel free to outsource OBGYN billing services to MediBillMD.
