How To Use CPT Code 56605 (2024)

CPT 56605 is a code for biopsy of vulva or perineum, specifically for one lesion. This article will cover the description, procedure, qualifying circ*mstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 56605 procedures.

1. What is CPT 56605?

CPT 56605 is a medical code used to describe a biopsy procedure performed on the vulva or perineum, specifically for one lesion. This code is used by medical coders and billers to accurately document and bill for this specific procedure.

2. 56605 CPT code description

The official description of CPT code 56605 is: “Biopsy of vulva or perineum (separate procedure); 1 lesion.”

3. Procedure

The CPT 56605 procedure involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider identifies the site of the lesion on the vulva or perineum.
3. Using scissors or a scalpel, the provider excises the lesion from the base of the vulva or perineum along with a surrounding margin of healthy tissue.
4. The excised specimen is sent to a laboratory for analysis.
5. The provider irrigates the area, checks for bleeding, and closes the incision.

4. Qualifying circ*mstances

Patients eligible to receive CPT code 56605 services are those who have a suspicious lesion on the vulva or perineum that requires a biopsy for further analysis and diagnosis. The biopsy should be performed as a separate procedure, not as part of a larger, related service. This code is only applicable for the excision and biopsy of the first lesion. For removal of each additional lesion, use +56606, Biopsy of vulva or perineum, each separate additional lesion.

5. When to use CPT code 56605

It is appropriate to bill the 56605 CPT code when a provider performs a biopsy of a single lesion on the vulva or perineum as a separate procedure. This code should not be reported when the biopsy is performed as part of a larger, related service. Additionally, this code is only applicable for the first lesion; for each additional lesion, use +56606.

6. Documentation requirements

To support a claim for CPT 56605, the following information should be documented:

• Patient’s medical history and physical examination findings
• Indication for the biopsy, including the location and appearance of the lesion
• Details of the procedure, including anesthesia, instruments used, and steps taken during the biopsy
• Post-procedure care, including any complications or follow-up instructions
• Pathology report with the results of the laboratory analysis

7. Billing guidelines

When billing for CPT code 56605, it is important to follow the appropriate guidelines and rules. This code is designated as a separate procedure, so it should not be reported when the provider performs the biopsy as part of a larger, related service. Additionally, this code is only applicable for the first lesion; for each additional lesion, use +56606. Ensure that all required documentation is included to support the claim and avoid potential denials or delays in payment.

8. Historical information

CPT 56605 was added to the Current Procedural Terminology system on January 1, 1993. The code was changed on January 1, 2010, with the previous descriptor being “Biopsy of vulva or perineum (separate procedure); one lesion.”

9. Similar codes to CPT 56605

Five similar codes to CPT 56605 and how they differentiate are:

• CPT 56606: This code is used for biopsy of vulva or perineum, each separate additional lesion, and should be used in conjunction with CPT 56605 for multiple lesions.
• CPT 56620: This code is for excision of the vulva or perineum, simple, and involves a more extensive removal of tissue than a biopsy.
• CPT 56625: This code is for excision of the vulva or perineum, radical, and involves an even more extensive removal of tissue than CPT 56620.
• CPT 56630: This code is for excision of the vulva or perineum, complete, and involves the removal of the entire vulva or perineum.
• CPT 56640: This code is for vulvectomy, partial, and involves the removal of a portion of the vulva.

10. Examples

Here are 10 detailed examples of CPT code 56605 procedures:

1. A 35-year-old female with a suspicious lesion on the vulva undergoes a biopsy under local anesthesia.
2. A 45-year-old female with a history of abnormal Pap smears has a perineal lesion biopsied during a separate office visit.
3. A 28-year-old female with a painful lesion on the vulva undergoes a biopsy to rule out malignancy.
4. A 55-year-old female with a history of vulvar itching and irritation has a biopsy of a suspicious lesion on the perineum.
5. A 40-year-old female with a pigmented lesion on the vulva undergoes a biopsy to rule out melanoma.
6. A 50-year-old female with a history of human papillomavirus (HPV) infection has a biopsy of a lesion on the vulva.
7. A 30-year-old female with a persistent lesion on the perineum undergoes a biopsy to determine the cause.
8. A 60-year-old female with a history of lichen sclerosus has a biopsy of a suspicious lesion on the vulva.
9. A 48-year-old female with a lesion on the vulva that has changed in appearance undergoes a biopsy to rule out malignancy.
10. A 42-year-old female with a history of vulvar intraepithelial neoplasia (VIN) has a biopsy of a new lesion on the perineum.