2025 CPT code 56605
Biopsy of vulva or perineum (separate procedure); one lesion.
Modifiers may be applicable to this code, such as modifier 51 (multiple procedures) if other procedures are performed during the same encounter, or modifier 22 (increased procedural services) if the biopsy is unusually complex.
Medical necessity for this code is established by the presence of a suspicious lesion requiring pathological evaluation to determine its nature (e.g., rule out cancer, infection, or other pathology).
The physician identifies the lesion, excises it with a scalpel or scissors, including a margin of healthy tissue. The specimen is sent to a lab for analysis. The incision is then irrigated, checked for bleeding, and closed.
In simple words: This procedure involves removing a small tissue sample from a suspicious area on the outer female genitals (vulva or perineum) to check for abnormalities. The sample is then sent to a lab for testing.
This code represents a biopsy of a single lesion on the vulva or perineum.The procedure involves excising the lesion along with a margin of healthy tissue for pathological analysis and diagnosis.
Example 1: A patient presents with a suspicious mole on her labia majora. A biopsy (56605) is performed to determine if it's cancerous., A patient has a persistent, non-healing sore on her perineum.The provider performs a biopsy (56605) to analyze the tissue., A woman has a raised, discolored lesion on her vulva.A biopsy (56605) is taken to investigate the lesion's nature.
Documentation should include the location and description of the lesion, the method of biopsy, and the size of the specimen removed.A pathology report is also required.
** It is crucial to distinguish a biopsy (56605) from a complete excision. A biopsy removes only a portion of the lesion for diagnostic purposes, while an excision removes the entire lesion.
- Payment Status: Active
- Specialties:Obstetrics and Gynecology, Dermatology, General Surgery
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center