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Reimbursement Advisor


Code for perineoplasty depends on setting

June 2006 · Vol. 18, No. 6

<huc>Q</huc> Can a perineoplasty be performed in the office as a minor procedure or does this require an operating room? Is there some way to bill for a simple repair in the office?

<huc>A</huc> CPT code 56810 (perineoplasty, repair of perineum, nonobstetric [separate procedure]) was valued under the Resource-Based Relative Value Scale as an inpatient procedure, and there are no practice expense relative value units added if the procedure is done in the office. That does not mean that a private payer will not pay for it in an office setting, but you would not be paid for the added expense of performing it in the office setting. Also keep in mind that the perineoplasty code, which has a 10-day global period, was valued based on hospital admission and subsequent hospital care as well, so if the payer denies it in the office setting it will be because you are not providing these services.

If a repair only is documented, your other possibility is to use codes 12001–12004 (simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.5 cm or less up to 12.5 cm). These codes do have a practice expense differential when the procedure is carried out in the office. Like the perineoplasty code, this code series has a 10-day global period.

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