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Official Description

Destruction of vaginal lesion(s); extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 57065 involves the extensive destruction of vaginal lesion(s) through various techniques such as laser surgery, electrosurgery, cryosurgery, or chemosurgery. Vaginal lesions refer to abnormal growths or changes in the vaginal tissue that may require intervention. The choice of destruction method is determined by the specific characteristics of the lesion and the physician's clinical judgment. Prior to the procedure, a local anesthetic may be administered to minimize discomfort for the patient. This extensive destruction technique is often more comprehensive than simple destruction, which is coded under CPT® Code 57061. In some cases, the destruction of the lesion may be performed in conjunction with scraping, also known as curettement, to ensure complete removal of the affected tissue. The use of laser energy, heat, cold, or chemical agents allows for targeted treatment of one or more lesions, aiming to effectively eliminate the abnormal tissue while preserving surrounding healthy tissue as much as possible.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure coded as CPT® 57065 is indicated for the treatment of extensive vaginal lesions that may present as abnormal growths or changes in the vaginal tissue. The following conditions may warrant the use of this procedure:

  • Vaginal Neoplasms Lesions that are benign or malignant in nature, requiring destruction to prevent further complications.
  • Persistent Lesions Lesions that have not responded to other forms of treatment and require more aggressive intervention.
  • Recurrent Lesions Lesions that have returned after previous treatments, necessitating extensive destruction to ensure complete removal.

2. Procedure

The procedure for the destruction of vaginal lesions using CPT® Code 57065 involves several key steps, which are detailed below:

  • Preparation The patient is positioned comfortably, and a local anesthetic is administered to minimize discomfort during the procedure. This step is crucial for ensuring patient comfort and cooperation.
  • Selection of Destruction Method The physician evaluates the type of lesion and selects the appropriate destruction technique, which may include laser surgery, electrosurgery, cryosurgery, or chemosurgery. The choice of method is based on the lesion's characteristics and the physician's expertise.
  • Application of Destruction Technique The selected method is applied to the lesion(s). For instance, if laser surgery is chosen, the physician uses focused laser energy to precisely target and destroy the abnormal tissue. In the case of electrosurgery, electrical currents are utilized to cut or coagulate the tissue. Cryosurgery involves freezing the lesion, while chemosurgery uses chemical agents to achieve destruction.
  • Monitoring and Assessment Throughout the procedure, the physician monitors the patient's response and the effectiveness of the destruction technique. Adjustments may be made as necessary to ensure optimal results.
  • Post-Destruction Care After the lesions have been destroyed, the physician may perform curettement to scrape away any remaining tissue, ensuring complete removal. The area is then assessed for any immediate complications, and post-procedure instructions are provided to the patient.

3. Post-Procedure

Following the extensive destruction of vaginal lesions, patients may experience some discomfort, swelling, or bleeding, which is typically manageable. The physician will provide specific post-procedure care instructions, which may include recommendations for pain management, activity restrictions, and signs of complications to watch for. Patients are usually advised to avoid sexual intercourse and the use of tampons for a specified period to allow for proper healing. Follow-up appointments may be scheduled to monitor the healing process and assess the effectiveness of the procedure.

Short Descr DESTRUCTION VAG LESION XTNSV
Medium Descr DESTRUCTION VAGINAL LESIONS EXTENSIVE
Long Descr Destruction of vaginal lesion(s); extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)
Status Code Active Code
Global Days 010 - Minor Procedure
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 1 - Statutory payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P1G - Major procedure - Other
MUE 1
CCS Clinical Classification 132 - Other OR therapeutic procedures, female organs
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
74 Discontinued out-patient hospital/ambulatory surgery center (asc) procedure after administration of anesthesia: due to extenuating circumstances or those that threaten the well being of the patient, the physician may terminate a surgical or diagnostic procedure after the administration of anesthesia (local, regional block(s), general) or after the procedure was started (incision made, intubation started, scope inserted, etc). under these circumstances, the procedure started but terminated can be reported by its usual procedure number and the addition of modifier 74. note: the elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. for physician reporting of a discontinued procedure, see modifier 53.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
AG Primary physician
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
GC This service has been performed in part by a resident under the direction of a teaching physician
KX Requirements specified in the medical policy have been met
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
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2025-01-01 Changed Short Description changed.
2011-01-01 Changed Short description changed.
2002-01-01 Changed Code description changed.
Pre-1990 Added Code added.
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