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Home , Cervicectomy, Colpocleisis, Colposcopy, Endocervical curettage, Enterocele, Hysteroscopy

SJH Procedures - Gynecology and Gynecology Services New Name Old Name CPT Code Service ABLATION, LESION, AND , USING CO2 LASER VAPORIZATION CERVIX/VULVA W CO2 LASER 56501 Destruction of lesion(s), vulva; simple (eg, laser , Gynecology electrosurgery, , chemosurgery) 56515 Destruction of lesion(s), vulva; extensive (eg, laser surgery, Gynecology electrosurgery, cryosurgery, chemosurgery) 57513 Cautery of cervix; laser ablation Gynecology OR EXCISION, LESION, AND EXCISION/BIOPSY (MASS/LESION//) FACE/NECK General, Gynecology, Plastics, ENT, Maxillofacial BIOPSY OR EXCISION, LESION, FACE AND NECK, 2 OR MORE EXCISE/BIOPSY (MASS/LESION/LIPOMA/CYST) MULTIPLE FACE/NECK 11102 Tangential biopsy of (eg, shave, scoop, saucerize, curette); General, Gynecology, single lesion Aesthetics, , Maxillofacial, ENT, Thoracic, Vascular, Cardiovascular, Plastics, Orthopedics 11103 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); General, Gynecology, each separate/additional lesion (list separately in addition to Aesthetics, Urology, code for primary procedure) Maxillofacial, ENT, Thoracic, Vascular, Cardiovascular, Plastics, Orthopedics 11104 Punch biopsy of skin (including simple closure, when General, Gynecology, performed); single lesion Aesthetics, Urology, Maxillofacial, ENT, Thoracic, Vascular, Cardiovascular, Plastics, Orthopedics 11105 Punch biopsy of skin (including simple closure, when General, Gynecology, performed); each separate/additional lesion (list separately in Aesthetics, Urology, addition to code for primary procedure) Maxillofacial, ENT, Thoracic, Vascular, Cardiovascular, Plastics, Orthopedics 11106 Incisional biopsy of skin (eg, wedge) (including simple closure, General, Gynecology, when performed); single lesion Aesthetics, Urology, Maxillofacial, ENT, Thoracic, Vascular, Cardiovascular, Plastics, Orthopedics 11107 Incisional biopsy of skin (eg, wedge) (including simple closure, General, Gynecology, when performed); each separate/additional lesion (list Aesthetics, Urology, separately in addition to code for primary procedure) Maxillofacial, ENT, Thoracic, Vascular, Cardiovascular, Plastics, Orthopedics BIOPSY OR EXCISION, LESION, LOWER BODY EXCISE/BIOPSY (MASS/LESION/LIPOMA/CYST) LOWER BODY General, Gynecology, Orthopedics, Plastics, Urology, , Aesthetics, Colorectal, Spine, Vascular, BIOPSY OR EXCISION, LESION, LOWER BODY, 2 OR MORE EXCISE/BIOPSY (MASS/LESION/LIPOMA/CYST) MULTIPLE LOWER BODY 11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); General, Gynecology, single lesion Orthopedics, Plastics, Urology, Aesthetics, Vascular, Maxillofacial, Thoracic, Cardiovascular, ENT, Colorectal, Podiatry

Page 1 of 20 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - Gynecology and Gynecology Oncology Services New Name Old Name CPT Code Service BIOPSY OR EXCISION, LESION, LOWER BODY, 2 OR MORE EXCISE/BIOPSY (MASS/LESION/LIPOMA/CYST) MULTIPLE LOWER BODY 11103 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); General, Gynecology, each separate/additional lesion (list separately in addition to Orthopedics, Plastics, Urology, code for primary procedure) Aesthetics, Vascular, Maxillofacial, Thoracic, Cardiovascular, ENT, Colorectal, Podiatry 11104 Punch biopsy of skin (including simple closure, when General, Gynecology, performed); single lesion Orthopedics, Plastics, Urology, Aesthetics, Vascular, Maxillofacial, Thoracic, Cardiovascular, ENT, Colorectal, Podiatry 11105 Punch biopsy of skin (including simple closure, when General, Gynecology, performed); each separate/additional lesion (list separately in Orthopedics, Plastics, Urology, addition to code for primary procedure) Aesthetics, Vascular, Maxillofacial, Thoracic, Cardiovascular, ENT, Colorectal, Podiatry 11106 Incisional biopsy of skin (eg, wedge) (including simple closure, General, Gynecology, when performed); single lesion Orthopedics, Plastics, Urology, Aesthetics, Vascular, Maxillofacial, Thoracic, Cardiovascular, ENT, Colorectal, Podiatry 11107 Incisional biopsy of skin (eg, wedge) (including simple closure, General, Gynecology, when performed); each separate/additional lesion (list Orthopedics, Plastics, Urology, separately in addition to code for primary procedure) Aesthetics, Vascular, Maxillofacial, Thoracic, Cardiovascular, ENT, Colorectal, Podiatry BIOPSY OR EXCISION, LESION, UPPER BODY EXCISION/BIOPSY ( MASS/LESION/LIPOMA/CYST) UPPER BODY General, Gynecology, Orthopedics, Plastics, ENT BIOPSY OR EXCISION, LESION, UPPER BODY, 2 OR MORE EXCISE/BIOPSY (MASS/LESION/LIPOMA/CYST) MULTIPLE UPPER BODY 11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); General, Gynecology, single lesion Orthopedics, Plastics, Aesthetics, Cardiac/Thoracic Robotics, Cardiovascular, Colorectal, ENT, Maxillofacial, Spine, Vascular 11103 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); General, Gynecology, each separate/additional lesion (list separately in addition to Orthopedics, Plastics, code for primary procedure) Aesthetics, Cardiac/Thoracic Robotics, Cardiovascular, Colorectal, ENT, Maxillofacial, Spine, Vascular 11104 Punch biopsy of skin (including simple closure, when General, Gynecology, performed); single lesion Orthopedics, Plastics, Aesthetics, Cardiac/Thoracic Robotics, Cardiovascular, Colorectal, ENT, Maxillofacial, Spine, Vascular Page 2 of 20 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - Gynecology and Gynecology Oncology Services New Name Old Name CPT Code Service BIOPSY OR EXCISION, LESION, UPPER BODY, 2 OR MORE EXCISE/BIOPSY (MASS/LESION/LIPOMA/CYST) MULTIPLE UPPER BODY 11105 Punch biopsy of skin (including simple closure, when General, Gynecology, performed); each separate/additional lesion (list separately in Orthopedics, Plastics, addition to code for primary procedure) Aesthetics, Cardiac/Thoracic Robotics, Cardiovascular, Colorectal, ENT, Maxillofacial, Spine, Vascular 11106 Incisional biopsy of skin (eg, wedge) (including simple closure, General, Gynecology, when performed); single lesion Orthopedics, Plastics, Aesthetics, Cardiac/Thoracic Robotics, Cardiovascular, Colorectal, ENT, Maxillofacial, Spine, Vascular 11107 Incisional biopsy of skin (eg, wedge) (including simple closure, General, Gynecology, when performed); each separate/additional lesion (list Orthopedics, Plastics, separately in addition to code for primary procedure) Aesthetics, Cardiac/Thoracic Robotics, Cardiovascular, Colorectal, ENT, Maxillofacial, Spine, Vascular CERCLAGE, CERVIX CERCLAGE CERVICAL 57700 Cerclage of uterine cervix, nonobstetrical Gynecology 59320 Cerclage of cervix, during ; vaginal Gynecology *59325 Cerclage of cervix, during pregnancy; abdominal Gynecology CHROMOPERTUBATION, LAPAROSCOPIC CHROMOTUBATION 58350 Chromotubation of oviduct, including materials Gynecology CLOSURE, FISTULA, VESICOVAGINAL FISTULECTOMY VESICOVAGINAL *51900 Closure of , abdominal approach Gynecology 57320 Closure of vesicovaginal fistula; vaginal approach Gynecology 57330 Closure of vesicovaginal fistula; transvesical and vaginal Gynecology approach COLPOCLEISIS VAGINAL 57120 Colpocleisis (Le Fort type) Gynecology COLPOPEXY, ABDOMINAL APPROACH SUSPENSION VAGINAL VAULT (ABDOMINAL APPROACH) *57280 Colpopexy, abdominal approach Gynecology COLPORRHAPHY COLPORRHAPHY 57200 Colporrhaphy, suture of injury of (nonobstetrical) Gynecology 57240 Anterior colporrhaphy, repair of with or without Gynecology repair of , including cystourethroscopy, when performed 57250 Posterior colporrhaphy, repair of with or without Gynecology perineorrhaphy 57260 Combined anteroposterior colporrhaphy, including Gynecology cystourethroscopy, when performed; COLPORRHAPHY, ANTERIOR, USING MESH IF INDICATED REPAIR ANTERIOR W/WO MESH 57240 Anterior colporrhaphy, repair of cystocele with or without Gynecology repair of urethrocele, including cystourethroscopy, when performed 57267 Insertion of mesh or other prosthesis for repair of Gynecology defect, each site (anterior, posterior compartment), vaginal approach (List separately in addition to code for primary procedure) COLPORRHAPHY, ANTERIOR, WITH COLPORRHAPHY POSTERIOR AND/OR REPAIR ANTERIOR &/ POSTERIOR &/ W SLING 57240 Anterior colporrhaphy, repair of cystocele with or without Gynecology ENTEROCELE REPAIR IF INDICATED, WITH SUBURETHRAL SLING CREATION repair of urethrocele, including cystourethroscopy, when performed

Page 3 of 20 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - Gynecology and Gynecology Oncology Services New Name Old Name CPT Code Service COLPORRHAPHY, ANTERIOR, WITH COLPORRHAPHY POSTERIOR AND/OR REPAIR ANTERIOR &/ POSTERIOR &/ ENTEROCELE W SLING 57250 Posterior colporrhaphy, repair of rectocele with or without Gynecology ENTEROCELE REPAIR IF INDICATED, WITH SUBURETHRAL SLING CREATION perineorrhaphy 57260 Combined anteroposterior colporrhaphy, including Gynecology cystourethroscopy, when performed; 57265 Combined anteroposterior colporrhaphy, including Gynecology cystourethroscopy, when performed; with enterocele repair 57268 Repair of enterocele, vaginal approach (separate procedure) Gynecology *57270 Repair of enterocele, abdominal approach (separate Gynecology procedure) 57288 Sling operation for stress incontinence (eg, fascia or synthetic) Gynecology COLPORRHAPHY, COMBINED ANTEROPOSTERIOR, WITH , REPAIR ANTERIOR&/ POSTERIOR &/ ENTEROCELE WITH SLING WITH 51992 Laparoscopy, surgical; sling operation for stress incontinence Gynecology ENTEROCELE REPAIR, AND URETHRAL SLING CREATION CYSTOSCOPY (eg, fascia or synthetic) 52000 Cystourethroscopy (separate procedure) Gynecology 57265 Combined anteroposterior colporrhaphy, including Gynecology cystourethroscopy, when performed; with enterocele repair 57288 Sling operation for stress incontinence (eg, fascia or synthetic) Gynecology COLPORRHAPHY, COMBINED ANTEROPOSTERIOR, WITH ENTEROCELE REPAIR ANTERIOR &/ POSTERIOR &/ ENTEROCELE 57265 Combined anteroposterior colporrhaphy, including Gynecology REPAIR cystourethroscopy, when performed; with enterocele repair 57267 Insertion of mesh or other prosthesis for repair of pelvic floor Gynecology defect, each site (anterior, posterior compartment), vaginal approach (List separately in addition to code for primary procedure) COLPORRHAPHY, COMBINED ANTEROPOSTERIOR, WITH PARAVAGINAL REPAIR ANTERIOR AND POSTERIOR W REPAIR PARA VAGINAL 57260 Combined anteroposterior colporrhaphy, including Gynecology DEFECT REPAIR cystourethroscopy, when performed; 57265 Combined anteroposterior colporrhaphy, including Gynecology cystourethroscopy, when performed; with enterocele repair 57284 Paravaginal defect repair (including repair of cystocele, if Gynecology performed); open abdominal approach 57285 Paravaginal defect repair (including repair of cystocele, if Gynecology performed); vaginal approach 57423 Paravaginal defect repair (including repair of cystocele, if Gynecology performed), laparoscopic approach COLPORRHAPHY, POSTERIOR, USING MESH IF INDICATED REPAIR POSTERIOR W/WO MESH 57250 Posterior colporrhaphy, repair of rectocele with or without Gynecology perineorrhaphy 57267 Insertion of mesh or other prosthesis for repair of pelvic floor Gynecology defect, each site (anterior, posterior compartment), vaginal approach (List separately in addition to code for primary procedure) COLPORRHAPHY, POSTERIOR, USING TRANSOBTURATOR TENSION-FREE COLPORRHAPHY POSTERIOR W/ WO PROLIFT 57250 Posterior colporrhaphy, repair of rectocele with or without Gynecology VAGINAL MESH IF INDICATED perineorrhaphy 57267 Insertion of mesh or other prosthesis for repair of pelvic floor Gynecology defect, each site (anterior, posterior compartment), vaginal approach (List separately in addition to code for primary procedure) COLPOSCOPY 56820 Colposcopy of the vulva; Gynecology 56821 Colposcopy of the vulva; with biopsy(s) Gynecology 57420 Colposcopy of the entire vagina, with cervix if present; Gynecology

Page 4 of 20 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - Gynecology and Gynecology Oncology Services New Name Old Name CPT Code Service COLPOSCOPY COLPOSCOPY 57421 Colposcopy of the entire vagina, with cervix if present; with Gynecology biopsy(s) of vagina/cervix 57452 Colposcopy of the cervix including upper/adjacent vagina; Gynecology 57454 Colposcopy of the cervix including upper/adjacent vagina; with Gynecology biopsy(s) of the cervix and endocervical curettage 57455 Colposcopy of the cervix including upper/adjacent vagina; with Gynecology biopsy(s) of the cervix 57456 Colposcopy of the cervix including upper/adjacent vagina; with Gynecology endocervical curettage 57460 Colposcopy of the cervix including upper/adjacent vagina; with Gynecology loop electrode biopsy(s) of the cervix 57461 Colposcopy of the cervix including upper/adjacent vagina; with Gynecology loop electrode conization of the cervix COLPOSUSPENSION, OPEN, BURCH SUSPENSION BLADDER NECK/BURCH PROCEDURE OPEN *51840 Anterior vesicourethropexy, or urethropexy (eg, Marshall- Gynecology Marchetti-Krantz, Burch); simple *51841 Anterior vesicourethropexy, or urethropexy (eg, Marshall- Gynecology Marchetti-Krantz, Burch); complicated (eg, secondary repair) CONE BIOPSY, CERVIX, USING CO2 LASER BIOPSY CO2 LASER CONE CERVIX 57520 Conization of cervix, with or without fulguration, with or Gynecology without , with or without repair; cold knife or laser CONE BIOPSY, CERVIX, USING COLD KNIFE CONIZATION CERVIX COLD KNIFE 57520 Conization of cervix, with or without fulguration, with or Gynecology without dilation and curettage, with or without repair; cold knife or laser CURETTAGE, ENDOCERVICAL Gynecology CYSTOSCOPY CYSTOSCOPY GYN 52000 Cystourethroscopy (separate procedure) Gynecology 52351 Cystourethroscopy, with and/or pyeloscopy; Gynecology diagnostic CYSTOSCOPY, WITH BOTULINUM TOXIN INJECTION CYSTOSCOPY WITH BOTOX INJECTION 52287 Cystourethroscopy, with injection(s) for chemodenervation of Gynecology, Urology the bladder CYSTOSCOPY, WITH URETERAL CATHETER INSERTION CYSTOSCOPY INSERTION URETERAL CATHETER 52005 Cystourethroscopy, with ureteral catheterization, with or Gynecology, Urology without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; DEBRIDEMENT, WOUND DEBRIDEMENT WOUND 11042 Debridement, subcutaneous tissue (includes and Plastics, Orthopedics, General, , if performed); first 20 sq cm or less Gynecology, Podiatry, Pacemakers, Vascular, Colorectal, Neurosurgery, Thoracic, Cardiac/Open Heart, Urology 11043 Debridement, muscle and/or fascia (includes epidermis, Plastics, Orthopedics, General, dermis, and subcutaneous tissue, if performed); first 20 sq cm Gynecology, Podiatry, or less Pacemakers, Vascular, Colorectal, Neurosurgery, Thoracic, Cardiac/Open Heart, Urology

Page 5 of 20 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - Gynecology and Gynecology Oncology Services New Name Old Name CPT Code Service DEBRIDEMENT, WOUND DEBRIDEMENT WOUND 11044 Debridement, bone (includes epidermis, dermis, subcutaneous Plastics, Orthopedics, General, tissue, muscle and/or fascia, if performed); first 20 sq cm or Gynecology, Podiatry, less Pacemakers, Vascular, Colorectal, Neurosurgery, Thoracic, Cardiac/Open Heart, Urology 11045 Debridement, subcutaneous tissue (includes epidermis and Plastics, Orthopedics, General, dermis, if performed); each additional 20 sq cm, or part Gynecology, Podiatry, thereof (List separately in addition to code for primary Pacemakers, Vascular, procedure) Colorectal, Neurosurgery, Thoracic, Cardiac/Open Heart, Urology 11046 Debridement, muscle and/or fascia (includes epidermis, Plastics, Orthopedics, General, dermis, and subcutaneous tissue, if performed); each Gynecology, Podiatry, additional 20 sq cm, or part thereof (List separately in addition Pacemakers, Vascular, to code for primary procedure) Colorectal, Neurosurgery, Thoracic, Cardiac/Open Heart, Urology 11047 Debridement, bone (includes epidermis, dermis, subcutaneous Plastics, Orthopedics, General, tissue, muscle and/or fascia, if performed); each additional 20 Gynecology, Podiatry, sq cm, or part thereof (List separately in addition to code for Pacemakers, Vascular, primary procedure) Colorectal, Neurosurgery, Thoracic, Cardiac/Open Heart, Urology 97597 Debridement (eg, high pressure waterjet with/without suction, Plastics, Orthopedics, General, sharp selective debridement with scissors, scalpel and forceps), Gynecology, Podiatry, open wound, (eg, fibrin, devitalized epidermis and/or dermis, Pacemakers, Vascular, exudate, debris, biofilm), including topical application(s), Colorectal, Neurosurgery, wound Thoracic, Cardiac/Open Heart, Urology 97598 Debridement (eg, high pressure waterjet with/without suction, Plastics, Orthopedics, General, sharp selective debridement with scissors, scalpel and forceps), Gynecology, Podiatry, open wound, (eg, fibrin, devitalized epidermis and/or dermis, Pacemakers, Vascular, exudate, debris, biofilm), including topical application(s), Colorectal, Neurosurgery, wound Thoracic, Cardiac/Open Heart, Urology 97602 Removal of devitalized tissue from wound(s), non-selective Plastics, Orthopedics, General, debridement, without (eg, wet-to-moist dressings, Gynecology, Podiatry, enzymatic, abrasion, larval ), including topical Pacemakers, Vascular, application(s), wound assessment, and instruction(s) for Colorectal, Neurosurgery, ongoing care, per sess Thoracic, Cardiac/Open Heart, Urology DILATION AND CURETTAGE, , USING SUCTION DILATATION AND CURETTAGE W SUCTION 58120 Dilation and curettage, diagnostic and/or therapeutic Gynecology (nonobstetrical) 59812 Treatment of incomplete , any trimester, completed Gynecology surgically 59820 Treatment of missed abortion, completed surgically; first Gynecology trimester

Page 6 of 20 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - Gynecology and Gynecology Oncology Services New Name Old Name CPT Code Service DILATION AND CURETTAGE, UTERUS, USING SUCTION DILATATION AND CURETTAGE W SUCTION 59821 Treatment of missed abortion, completed surgically; second Gynecology trimester 59840 Induced abortion, by dilation and curettage Gynecology 59870 Uterine evacuation and curettage for hydatidiform mole Gynecology DILATION AND CURETTAGE, UTERUS, USING SUCTION, WITH DILATATION+CURETTAGEWSUCTIONWENDOMETRIAL 58120 Dilation and curettage, diagnostic and/or therapeutic Gynecology RADIOFREQUENCY ABLATION OF ENTIRE ABLATIONWNOVASURE (nonobstetrical) 58353 , thermal, without hysteroscopic guidance Gynecology DILATION AND CURETTAGE, UTERUS, WITH LOOP ELECTROSURGICAL DILATATION+CURETTAGEWLOOP ELECTROSURGICAL EXCISE PROCEDURE 57460 Colposcopy of the cervix including upper/adjacent vagina; with Gynecology EXCISION PROCEDURE (LEEP) OF CERVIX loop electrode biopsy(s) of the cervix 58120 Dilation and curettage, diagnostic and/or therapeutic Gynecology (nonobstetrical) DILATION, WITH ENDOCERVICAL AND UTERINE CURETTAGE DILATATION AND CURETTAGE / ENDOCERVICAL CURETTAGE 58120 Dilation and curettage, diagnostic and/or therapeutic Gynecology (nonobstetrical) EVACUATION, HEMATOMA EVACUATION OF HEMATOMA Gynecology, Gynecology Oncology, General, Bariatric, Spine, Neurosurgery, Plastics, Cardiac/Open Heart, Thoracic, General Robotics, Gynecology Robotics, Urology, Urology Robotics, Vascular EXCISION OR REVISION, URETHRAL SLING, WITH CYSTOSCOPY REVISION/REMOVAL SUBURETHRAL SLING W CYSTOSCOPY 52000 Cystourethroscopy (separate procedure) Gynecology 53442 Removal or revision of sling for male urinary incontinence (eg, Gynecology fascia or synthetic) 57287 Removal or revision of sling for stress incontinence (eg, fascia Gynecology or synthetic) EXCISION, CYST, , LAPAROSCOPIC CYSTECTOMY OVARIAN (OPERATIVE) LAPAROSCOPY 58662 Laparoscopy, surgical; with fulguration or excision of lesions of Gynecology the ovary, pelvic viscera, or peritoneal surface by any method EXCISION, CYST, OVARY, OPEN CYSTECTOMY OVARIAN OPEN 58925 Ovarian cystectomy, unilateral or bilateral Gynecology EXCISION, , LAPAROSCOPIC REMOVAL ECTOPIC PREGNANCY LAPAROSCOPIC 59150 Laparoscopic treatment of ectopic pregnancy; without Gynecology and/or 59151 Laparoscopic treatment of ectopic pregnancy; with Gynecology salpingectomy and/or oophorectomy EXCISION, LESION, VULVA OR VAGINA EXCISION (VULVAR/VAGINAL) (LESION/CYST) 11420 Excision, benign lesion including margins, except Gynecology (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less 11421 Excision, benign lesion including margins, except skin tag Gynecology (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm 11422 Excision, benign lesion including margins, except skin tag Gynecology (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm 11423 Excision, benign lesion including margins, except skin tag Gynecology (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm 11424 Excision, benign lesion including margins, except skin tag Gynecology (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm

Page 7 of 20 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - Gynecology and Gynecology Oncology Services New Name Old Name CPT Code Service EXCISION, LESION, VULVA OR VAGINA EXCISION (VULVAR/VAGINAL) (LESION/CYST) 11426 Excision, benign lesion including margins, except skin tag Gynecology (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm 11620 Excision, malignant lesion including margins, scalp, neck, Gynecology hands, feet, genitalia; excised diameter 0.5 cm or less 11621 Excision, malignant lesion including margins, scalp, neck, Gynecology hands, feet, genitalia; excised diameter 0.6 to 1.0 cm 11622 Excision, malignant lesion including margins, scalp, neck, Gynecology hands, feet, genitalia; excised diameter 1.1 to 2.0 cm 11623 Excision, malignant lesion including margins, scalp, neck, Gynecology hands, feet, genitalia; excised diameter 2.1 to 3.0 cm 11624 Excision, malignant lesion including margins, scalp, neck, Gynecology hands, feet, genitalia; excised diameter 3.1 to 4.0 cm 11626 Excision, malignant lesion including margins, scalp, neck, Gynecology hands, feet, genitalia; excised diameter over 4.0 cm 56501 Destruction of lesion(s), vulva; simple (eg, laser surgery, Gynecology electrosurgery, cryosurgery, chemosurgery) 56515 Destruction of lesion(s), vulva; extensive (eg, laser surgery, Gynecology electrosurgery, cryosurgery, chemosurgery) 57061 Destruction of vaginal lesion(s); simple (eg, laser surgery, Gynecology electrosurgery, cryosurgery, chemosurgery) 57065 Destruction of vaginal lesion(s); extensive (eg, laser surgery, Gynecology electrosurgery, cryosurgery, chemosurgery) EXCISIONAL BIOPSY, , LOWER BODY EXCISIONAL BIOPSY LYMPH NODE LOWER BODY 38500 Biopsy or excision of lymph node(s); open, superficial General, Gynecology, Orthopedics, Plastics 38505 Biopsy or excision of lymph node(s); by needle, superficial (eg, General, Gynecology, cervical, inguinal, axillary) Orthopedics, Plastics 38531 Biopsy or excision of lymph node(s); open, inguinofemoral General, Gynecology, node(s) Orthopedics, Plastics EXCISIONAL BIOPSY, LYMPH NODE, UPPER BODY EXCISIONAL BIOPSY LYMPH NODE UPPER BODY 38500 Biopsy or excision of lymph node(s); open, superficial General, Gynecology, Orthopedics, Plastics 38510 Biopsy or excision of lymph node(s); open, deep cervical General, Gynecology, node(s) Orthopedics, Plastics 38520 Biopsy or excision of lymph node(s); open, deep cervical General, Gynecology, node(s) with excision scalene fat pad Orthopedics, Plastics 38525 Biopsy or excision of lymph node(s); open, deep axillary node(s) General, Gynecology, Orthopedics, Plastics 38530 Biopsy or excision of lymph node(s); open, internal mammary General, Gynecology, node(s) Orthopedics, Plastics EXENTERATION, EXENTERATION PELVIC *45126 for colorectal malignancy, with Gynecology proctectomy (with or without ), with removal of bladder and ureteral transplantations, and/or , or , with or without removal of tube(s), with or without removal of ovary(

Page 8 of 20 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - Gynecology and Gynecology Oncology Services New Name Old Name CPT Code Service EXENTERATION, PELVIS EXENTERATION PELVIC *51597 Pelvic exenteration, complete, for vesical, prostatic or urethral Gynecology malignancy, with removal of bladder and ureteral transplantations, with or without hysterectomy and/or abdominoperineal resection of and colon and colostomy, or any combination there *58240 Pelvic exenteration for gynecologic malignancy, with total Gynecology abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal rese GYN DILATATION CURETTAGE PROCEDURE GP PER MD Gynecology GYN LAPAROSCOPY PROCEDURE GROUP PER MD Gynecology GYN PROCEDURE GROUP PER MD Gynecology GYN VAGINAL PROCEDURE CYSTOSCOPY SLING SUSPENSION GP PER MD Gynecology GYN VAGINAL PROCEDURE GROUP PER MD Gynecology HYMENECTOMY HYMENECTOMY 56700 Partial hymenectomy or revision of hymenal ring Gynecology HYSTERECTOMY, ROBOT-ASSISTED, USING XI, WITH BILATERAL SALPINGO- HYSTERECTOMY LAPAROSCOPIC POSS. TUBES + W XI ROBOTIC 58542 Laparoscopy, surgical, supracervical hysterectomy, for uterus Gynecology Robotics OOPHORECTOMY IF INDICATED 250 g or less; with removal of tube(s) and/or ovary(s) 58544 Laparoscopy, surgical, supracervical hysterectomy, for uterus Gynecology Robotics greater than 250 g; with removal of tube(s) and/or ovary(s) 58552 Laparoscopy, surgical, with vaginal hysterectomy, for uterus Gynecology Robotics 250 g or less; with removal of tube(s) and/or ovary(s) 58554 Laparoscopy, surgical, with vaginal hysterectomy, for uterus Gynecology Robotics greater than 250 g; with removal of tube(s) and/or ovary(s) 58571 Laparoscopy, surgical, with total hysterectomy, for uterus 250 Gynecology Robotics g or less; with removal of tube(s) and/or ovary(s) 58573 Laparoscopy, surgical, with total hysterectomy, for uterus Gynecology Robotics greater than 250 g; with removal of tube(s) and/or ovary(s) HYSTERECTOMY, SUPRACERVICAL, ABDOMINAL HYSTERECTOMY SUPRACERVICAL ABDOMINAL *58180 Supracervical abdominal hysterectomy (subtotal Gynecology hysterectomy), with or without removal of tube(s), with or without removal of ovary(s) 58541 Laparoscopy, surgical, supracervical hysterectomy, for uterus Gynecology 250 g or less; 58542 Laparoscopy, surgical, supracervical hysterectomy, for uterus Gynecology 250 g or less; with removal of tube(s) and/or ovary(s) 58543 Laparoscopy, surgical, supracervical hysterectomy, for uterus Gynecology greater than 250 g; 58544 Laparoscopy, surgical, supracervical hysterectomy, for uterus Gynecology greater than 250 g; with removal of tube(s) and/or ovary(s) HYSTERECTOMY, SUPRACERVICAL, ABDOMINAL, WITH BILATERAL HYSTERECTOMY SUPRACERVICAL ABDOMINAL TUBES+OVARY *58180 Supracervical abdominal hysterectomy (subtotal Gynecology SALPINGO-OOPHORECTOMY hysterectomy), with or without removal of tube(s), with or without removal of ovary(s) HYSTERECTOMY, SUPRACERVICAL, LAPAROSCOPIC HYSTERECTOMY SUPRACERVICAL LAPAROSCOPY 58541 Laparoscopy, surgical, supracervical hysterectomy, for uterus Gynecology 250 g or less; 58542 Laparoscopy, surgical, supracervical hysterectomy, for uterus Gynecology 250 g or less; with removal of tube(s) and/or ovary(s)

Page 9 of 20 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - Gynecology and Gynecology Oncology Services New Name Old Name CPT Code Service HYSTERECTOMY, SUPRACERVICAL, LAPAROSCOPIC HYSTERECTOMY SUPRACERVICAL LAPAROSCOPY 58543 Laparoscopy, surgical, supracervical hysterectomy, for uterus Gynecology greater than 250 g; 58544 Laparoscopy, surgical, supracervical hysterectomy, for uterus Gynecology greater than 250 g; with removal of tube(s) and/or ovary(s) HYSTERECTOMY, SUPRACERVICAL, LAPAROSCOPIC, WITH SALPINGO- HYSTERECTOMY SUPRACERVICAL LAPAROSCOPY SALPINGO- 58542 Laparoscopy, surgical, supracervical hysterectomy, for uterus Gynecology OOPHORECTOMY OOPHRECTOMY 250 g or less; with removal of tube(s) and/or ovary(s) 58544 Laparoscopy, surgical, supracervical hysterectomy, for uterus Gynecology greater than 250 g; with removal of tube(s) and/or ovary(s) HYSTERECTOMY, TOTAL, ABDOMINAL HYSTERECTOMY TOTAL ABDOMINAL *58150 Total abdominal hysterectomy (corpus and cervix), with or Gynecology without removal of tube(s), with or without removal of ovary(s); 58570 Laparoscopy, surgical, with total hysterectomy, for uterus 250 Gynecology g or less; 58571 Laparoscopy, surgical, with total hysterectomy, for uterus 250 Gynecology g or less; with removal of tube(s) and/or ovary(s) 58572 Laparoscopy, surgical, with total hysterectomy, for uterus Gynecology greater than 250 g; 58573 Laparoscopy, surgical, with total hysterectomy, for uterus Gynecology greater than 250 g; with removal of tube(s) and/or ovary(s) HYSTERECTOMY, TOTAL, ABDOMINAL, WITH SALPINGO-OOPHORECTOMY HYSTERECTOMY TOTAL ABDOMINAL SALPINGO OOPHORECTOMY *58150 Total abdominal hysterectomy (corpus and cervix), with or Gynecology without removal of tube(s), with or without removal of ovary(s); *58200 Total abdominal hysterectomy, including partial , Gynecology with para-aortic and pelvic lymph node sampling, with or without removal of tube(s), with or without removal of ovary(s) *58210 Radical abdominal hysterectomy, with bilateral total pelvic Gynecology lymphadenectomy and para-aortic lymph node sampling (biopsy), with or without removal of tube(s), with or without removal of ovary(s) HYSTERECTOMY, TOTAL, LAPAROSCOPIC HYSTERECTOMY LAPAROSCOPIC TOTAL 58570 Laparoscopy, surgical, with total hysterectomy, for uterus 250 Gynecology g or less; 58571 Laparoscopy, surgical, with total hysterectomy, for uterus 250 Gynecology g or less; with removal of tube(s) and/or ovary(s) 58572 Laparoscopy, surgical, with total hysterectomy, for uterus Gynecology greater than 250 g; 58573 Laparoscopy, surgical, with total hysterectomy, for uterus Gynecology greater than 250 g; with removal of tube(s) and/or ovary(s) HYSTERECTOMY, TOTAL, LAPAROSCOPIC, WITH BILATERAL SALPINGO- HYSTERECTOMY LAPAROSCOPIC TOTAL W TUBES OVARIES *58548 Laparoscopy, surgical, with radical hysterectomy, with bilateral Gynecology OOPHORECTOMY total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with removal of tube(s) and ovary(s), if performed 58571 Laparoscopy, surgical, with total hysterectomy, for uterus 250 Gynecology g or less; with removal of tube(s) and/or ovary(s) 58573 Laparoscopy, surgical, with total hysterectomy, for uterus Gynecology greater than 250 g; with removal of tube(s) and/or ovary(s) HYSTERECTOMY, TOTAL, LAPAROSCOPIC, WITH BILATERAL SALPINGO- HYSTERECTOMY LAPAROSCOPY TOTAL TUBES & OVARIES PELVIC NODE 38571 Laparoscopy, surgical; with bilateral total pelvic Gynecology Oncology OOPHORECTOMY, PELVIC LYMPHADENECTOMY, WASHING FOR DISSECTION/WASHING W CYSTOSCOPY lymphadenectomy CYTOLOGY, AND CYSTOSCOPY Page 10 of 20 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - Gynecology and Gynecology Oncology Services New Name Old Name CPT Code Service HYSTERECTOMY, TOTAL, LAPAROSCOPIC, WITH BILATERAL SALPINGO- HYSTERECTOMY LAPAROSCOPY TOTAL TUBES & OVARIES PELVIC NODE 52000 Cystourethroscopy (separate procedure) Gynecology Oncology OOPHORECTOMY, PELVIC LYMPHADENECTOMY, WASHING FOR DISSECTION/WASHING W CYSTOSCOPY CYTOLOGY, AND CYSTOSCOPY 58542 Laparoscopy, surgical, supracervical hysterectomy, for uterus Gynecology Oncology 250 g or less; with removal of tube(s) and/or ovary(s) 58544 Laparoscopy, surgical, supracervical hysterectomy, for uterus Gynecology Oncology greater than 250 g; with removal of tube(s) and/or ovary(s) 58552 Laparoscopy, surgical, with vaginal hysterectomy, for uterus Gynecology Oncology 250 g or less; with removal of tube(s) and/or ovary(s) 58554 Laparoscopy, surgical, with vaginal hysterectomy, for uterus Gynecology Oncology greater than 250 g; with removal of tube(s) and/or ovary(s) 58571 Laparoscopy, surgical, with total hysterectomy, for uterus 250 Gynecology Oncology g or less; with removal of tube(s) and/or ovary(s) 58573 Laparoscopy, surgical, with total hysterectomy, for uterus Gynecology Oncology greater than 250 g; with removal of tube(s) and/or ovary(s) HYSTERECTOMY, TOTAL, VAGINAL, WITH SALPINGO-OOPHORECTOMY HYSTERECTOMY VAGINAL TOTAL SALPINGO OOPHORECTOMY 58262 Vaginal hysterectomy, for uterus 250 g or less; with removal of Gynecology tube(s), and/or ovary(s) 58291 Vaginal hysterectomy, for uterus greater than 250 g; with Gynecology removal of tube(s) and/or ovary(s) HYSTERECTOMY, VAGINAL HYSTERECTOMY VAGINAL 58260 Vaginal hysterectomy, for uterus 250 g or less; Gynecology 58262 Vaginal hysterectomy, for uterus 250 g or less; with removal of Gynecology tube(s), and/or ovary(s) 58290 Vaginal hysterectomy, for uterus greater than 250 g; Gynecology 58291 Vaginal hysterectomy, for uterus greater than 250 g; with Gynecology removal of tube(s) and/or ovary(s) HYSTERECTOMY, VAGINAL, LAPAROSCOPY-ASSISTED HYSTERECTOMY LAPAROSCOPIC VAGINAL 58550 Laparoscopy, surgical, with vaginal hysterectomy, for uterus Gynecology 250 g or less; 58552 Laparoscopy, surgical, with vaginal hysterectomy, for uterus Gynecology 250 g or less; with removal of tube(s) and/or ovary(s) 58553 Laparoscopy, surgical, with vaginal hysterectomy, for uterus Gynecology greater than 250 g; 58554 Laparoscopy, surgical, with vaginal hysterectomy, for uterus Gynecology greater than 250 g; with removal of tube(s) and/or ovary(s) HYSTERECTOMY, VAGINAL, LAPAROSCOPY-ASSISTED, WITH BILATERAL HYSTERECTOMY LAPAROSCOPIC VAGINAL W TUBES OVARIES 58552 Laparoscopy, surgical, with vaginal hysterectomy, for uterus Gynecology SALPINGO-OOPHORECTOMY 250 g or less; with removal of tube(s) and/or ovary(s) 58554 Laparoscopy, surgical, with vaginal hysterectomy, for uterus Gynecology greater than 250 g; with removal of tube(s) and/or ovary(s) HYSTERECTOMY, VAGINAL, LAPAROSCOPY-ASSISTED, WITH BILATERAL HYSTERECTOMY LAPAROSCOPIC VAGINAL TUBES OVARIES POSS. OPEN 58552 Laparoscopy, surgical, with vaginal hysterectomy, for uterus Gynecology SALPINGO-OOPHORECTOMY, WITH CONVERSION TO OPEN APPROACH IF 250 g or less; with removal of tube(s) and/or ovary(s) INDICATED 58554 Laparoscopy, surgical, with vaginal hysterectomy, for uterus Gynecology greater than 250 g; with removal of tube(s) and/or ovary(s) HYSTERECTOMY, VAGINAL, LAPAROSCOPY-ASSISTED, WITH SALPINGO- HYSTERECTOMY LAPAROSCPY VAGINAL TUBESOVARIES 38571 Laparoscopy, surgical; with bilateral total pelvic Gynecology OOPHORECTOMY AND LYMPHADENECTOMY LYMPHADENECTOMY lymphadenectomy 58552 Laparoscopy, surgical, with vaginal hysterectomy, for uterus Gynecology 250 g or less; with removal of tube(s) and/or ovary(s)

Page 11 of 20 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - Gynecology and Gynecology Oncology Services New Name Old Name CPT Code Service HYSTERECTOMY, VAGINAL, LAPAROSCOPY-ASSISTED, WITH SALPINGO- HYSTERECTOMY LAPAROSCPY VAGINAL TUBESOVARIES 58554 Laparoscopy, surgical, with vaginal hysterectomy, for uterus Gynecology OOPHORECTOMY AND LYMPHADENECTOMY LYMPHADENECTOMY greater than 250 g; with removal of tube(s) and/or ovary(s) HYSTERECTOMY, VAGINAL, LAPAROSCOPY-ASSISTED, WITH SLING HYSTERECTOMY LAPAROSCOPIC VAGINAL W SLING W CYSTOSCOPY 51992 Laparoscopy, surgical; sling operation for stress incontinence Gynecology OPERATION AND CYSTOSCOPY (eg, fascia or synthetic) 52000 Cystourethroscopy (separate procedure) Gynecology 57288 Sling operation for stress incontinence (eg, fascia or synthetic) Gynecology 58550 Laparoscopy, surgical, with vaginal hysterectomy, for uterus Gynecology 250 g or less; 58552 Laparoscopy, surgical, with vaginal hysterectomy, for uterus Gynecology 250 g or less; with removal of tube(s) and/or ovary(s) 58553 Laparoscopy, surgical, with vaginal hysterectomy, for uterus Gynecology greater than 250 g; 58554 Laparoscopy, surgical, with vaginal hysterectomy, for uterus Gynecology greater than 250 g; with removal of tube(s) and/or ovary(s) HYSTERECTOMY, VAGINAL, WITH ANTERIOR COLPORRHAPHY, POSTERIOR HYSTERECTOMY VAGINAL REPAIR ANTERIOR&/POSTERIOR&/ ENTEROCELE 57240 Anterior colporrhaphy, repair of cystocele with or without Gynecology COLPORRHAPHY, AND/OR ENTEROCELE REPAIR IF INDICATED repair of urethrocele, including cystourethroscopy, when performed 57250 Posterior colporrhaphy, repair of rectocele with or without Gynecology perineorrhaphy 57268 Repair of enterocele, vaginal approach (separate procedure) Gynecology *57270 Repair of enterocele, abdominal approach (separate Gynecology procedure) 58260 Vaginal hysterectomy, for uterus 250 g or less; Gynecology 58270 Vaginal hysterectomy, for uterus 250 g or less; with repair of Gynecology enterocele 58290 Vaginal hysterectomy, for uterus greater than 250 g; Gynecology 58294 Vaginal hysterectomy, for uterus greater than 250 g; with Gynecology repair of enterocele HYSTERECTOMY, VAGINAL, WITH CYSTOSCOPY AND SUBURETHERAL HYSTERECTOMY VAGINAL W SUBURETHERAL SLING W CYSTOSCOPY 52000 Cystourethroscopy (separate procedure) Gynecology SLING CREATION 57288 Sling operation for stress incontinence (eg, fascia or synthetic) Gynecology 58260 Vaginal hysterectomy, for uterus 250 g or less; Gynecology 58262 Vaginal hysterectomy, for uterus 250 g or less; with removal of Gynecology tube(s), and/or ovary(s) 58290 Vaginal hysterectomy, for uterus greater than 250 g; Gynecology 58291 Vaginal hysterectomy, for uterus greater than 250 g; with Gynecology removal of tube(s) and/or ovary(s) HYSTEROSCOPY HYSTEROSCOPY 58555 Hysteroscopy, diagnostic (separate procedure) Gynecology 58558 Hysteroscopy, surgical; with sampling (biopsy) of endometrium Gynecology and/or polypectomy, with or without D & C 58559 Hysteroscopy, surgical; with lysis of intrauterine adhesions Gynecology (any method) 58560 Hysteroscopy, surgical; with division or resection of Gynecology intrauterine septum (any method) 58561 Hysteroscopy, surgical; with removal of leiomyomata Gynecology 58562 Hysteroscopy, surgical; with removal of impacted foreign body Gynecology

Page 12 of 20 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - Gynecology and Gynecology Oncology Services New Name Old Name CPT Code Service HYSTEROSCOPY HYSTEROSCOPY 58563 Hysteroscopy, surgical; with endometrial ablation (eg, Gynecology endometrial resection, electrosurgical ablation, thermoablation) 58565 Hysteroscopy, surgical; with bilateral Gynecology cannulation to induce occlusion by placement of permanent implants HYSTEROSCOPY, WITH BALLOON ENDOMETRIAL THERMAL ABLATION HYSTEROSCOPY ABLATION ENDOMETRIUM THERMACHOICE 58563 Hysteroscopy, surgical; with endometrial ablation (eg, Gynecology endometrial resection, electrosurgical ablation, thermoablation) HYSTEROSCOPY, WITH DILATION AND CURETTAGE OF UTERUS HYSTEROSCOPY W DILATATION CURETTAGE 58558 Hysteroscopy, surgical; with sampling (biopsy) of endometrium Gynecology and/or polypectomy, with or without D & C HYSTEROSCOPY, WITH DILATION AND CURETTAGE OF UTERUS AND HYSTEROSCOPY DILATE CURETTAGE ENDOMETRIAL ABLATION NOVASURE 58563 Hysteroscopy, surgical; with endometrial ablation (eg, Gynecology NOVASURE ENDOMETRIAL ABLATION endometrial resection, electrosurgical ablation, thermoablation) HYSTEROSCOPY, WITH DILATION AND CURETTAGE OF UTERUS AND HYSTEROSCOPY D + C RESECTION FIBROID/ W MYOSURE 58558 Hysteroscopy, surgical; with sampling (biopsy) of endometrium Gynecology POLYPECTOMY OR USING MYOSURE TISSUE and/or polypectomy, with or without D & C REMOVAL SYSTEM 58561 Hysteroscopy, surgical; with removal of leiomyomata Gynecology HYSTEROSCOPY, WITH DILATION AND CURETTAGE OF UTERUS, WITH HYSTEROSCOPY DILATATION CURETTE RESECT ENDOMETRIUM/FIBROID 58561 Hysteroscopy, surgical; with removal of leiomyomata Gynecology ENDOMETRIAL EXCISION OR MYOMECTOMY 58563 Hysteroscopy, surgical; with endometrial ablation (eg, Gynecology endometrial resection, electrosurgical ablation, thermoablation) HYSTEROSCOPY, WITH DILATION AND CURETTAGE OF UTERUS, WITH HYSTEROSCOPY DILITATION CURETTAGE MYOMECTOMY/ENDOMETRIAL 58558 Hysteroscopy, surgical; with sampling (biopsy) of endometrium Gynecology ENDOMETRIAL EXCISION, POLYPECTOMY, AND/OR MYOMECTOMY IF RESECTION/POLYPECTOMY and/or polypectomy, with or without D & C INDICATED 58563 Hysteroscopy, surgical; with endometrial ablation (eg, Gynecology endometrial resection, electrosurgical ablation, thermoablation) HYSTEROSCOPY, WITH DILATION AND CURETTAGE OF UTERUS, WITH HYSTEROSCOPY DILATATION CURETTAGE POLYPECTOMY/MYOMECTOMY 58558 Hysteroscopy, surgical; with sampling (biopsy) of endometrium Gynecology POLYPECTOMY OR MYOMECTOMY and/or polypectomy, with or without D & C 58561 Hysteroscopy, surgical; with removal of leiomyomata Gynecology HYSTEROSCOPY, WITH DILATION AND CURETTAGE, UTERUS, USING HYSTEROSCOPY DILATATION CURRETAGE W SUCTION 58558 Hysteroscopy, surgical; with sampling (biopsy) of endometrium Gynecology SUCTION and/or polypectomy, with or without D & C HYSTEROSCOPY, WITH LAPAROSCOPIC EXCISION HYSTEROSCOPY LAPAROSCOPY OPERATIVE OVARIAN CYSTECTOMY 58555 Hysteroscopy, diagnostic (separate procedure) Gynecology 58662 Laparoscopy, surgical; with fulguration or excision of lesions of Gynecology the ovary, pelvic viscera, or peritoneal surface by any method HYSTEROSCOPY, WITH LAPAROSCOPIC SALPINGO-OOPHORECTOMY HYSTEROSCOPY LAPAROSCOPY OPERATIVE SALPINGO-OOPHORECTOMY 58555 Hysteroscopy, diagnostic (separate procedure) Gynecology 58661 Laparoscopy, surgical; with removal of adnexal structures Gynecology (partial or total oophorectomy and/or salpingectomy) INCISION AND DRAINAGE INCISION AND DRAINAGE General, Colorectal, Cardiac/Open Heart, Gynecology, Vascular INJECTION, THERAPEUTIC AGENT INJECTION THERAPEUTIC Orthopedics, Plastics, Gynecology, Pacemakers, Podiatry, General, Vascular, Dental Surgery

Page 13 of 20 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - Gynecology and Gynecology Oncology Services New Name Old Name CPT Code Service INSERTION, BRACHYTHERAPY DELIVERY DEVICE INSERTION RADIUM/CESIUM APPLICATOR 19296 Placement of radiotherapy afterloading expandable catheter Gynecology (single or multichannel) into the breast for interstitial radioelement application following partial , includes imaging guidance; on date separate from partial mastectomy 19297 Placement of radiotherapy afterloading expandable catheter Gynecology (single or multichannel) into the breast for interstitial radioelement application following partial mastectomy, includes imaging guidance; concurrent with partial mastectomy (list separately in a 19298 Placement of radiotherapy after loading brachytherapy Gynecology catheters (multiple tube and button type) into the breast for interstitial radioelement application following (at the time of or subsequent to) partial mastectomy, includes imaging guidance 20555 Placement of needles or catheters into muscle and/or soft Gynecology tissue for subsequent interstitial radioelement application (at the time of or subsequent to the procedure) 31643 , rigid or flexible, including fluoroscopic Gynecology guidance, when performed; with placement of catheter(s) for intracavitary radioelement application 41019 Placement of needles, catheters, or other device(s) into the Gynecology head and/or neck region (percutaneous, transoral, or transnasal) for subsequent interstitial radioelement application 55875 Transperineal placement of needles or catheters into Gynecology for interstitial radioelement application, with or without cystoscopy 55920 Placement of needles or catheters into pelvic organs and/or Gynecology genitalia (except prostate) for subsequent interstitial radioelement application 57155 Insertion of uterine tandem and/or vaginal ovoids for clinical Gynecology brachytherapy 57156 Insertion of a vaginal radiation afterloading apparatus for Gynecology clinical brachytherapy INSERTION, CATHETER, WITH SUBCUTANEOUS PORT, PERITONEAL INSERTION INTRAPERITONEAL PORTACATH 49419 Insertion of tunneled intraperitoneal catheter, with Gynecology subcutaneous port (ie, totally implantable) INSERTION, CATHETER, WITH SUBCUTANEOUS PORT, PERITONEAL, INSERTION INTRAPERITONEAL PORTACATH LAPAROSCOPIC 49324 Laparoscopy, surgical; with insertion of tunneled Gynecology LAPAROSCOPIC intraperitoneal catheter INSERTION, SMIT SLEEVE INSERTION SMITT RADIATION SLEEVE 57156 Insertion of a vaginal radiation afterloading apparatus for Gynecology clinical brachytherapy INSERTION, SUBURETHRAL SLING, WITH CYSTOSCOPY INSERTION SUBURETHRAL SLING W CYSTOSCOPY 51992 Laparoscopy, surgical; sling operation for stress incontinence Gynecology, Urology (eg, fascia or synthetic) 52000 Cystourethroscopy (separate procedure) Gynecology, Urology 53440 Sling operation for correction of male urinary incontinence (eg, Gynecology, Urology fascia or synthetic) 57287 Removal or revision of sling for stress incontinence (eg, fascia Gynecology, Urology or synthetic) 57288 Sling operation for stress incontinence (eg, fascia or synthetic) Gynecology, Urology

Page 14 of 20 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - Gynecology and Gynecology Oncology Services New Name Old Name CPT Code Service LABOR & DELIVERY MISCELLANEOUS PROCEDURE LABOR + DELIVERY MISCELLANEOUS PROCEDURE 59409 Vaginal delivery only (with or without and/or Gynecology forceps); *59514 Cesarean delivery only; Gynecology 59612 Vaginal delivery only, after previous cesarean delivery (with or Gynecology without episiotomy and/or forceps); *59620 Cesarean delivery only, following attempted vaginal delivery Gynecology after previous cesarean delivery; LAPAROSCOPY LAPAROSCOPY 49320 Laparoscopy, , peritoneum, and omentum, Gynecology, General, diagnostic, with or without collection of specimen(s) by Colorectal brushing or washing (separate procedure) LAPAROSCOPY, WITH BURCH COLPOSUSPENSION SUSPENSION BLADDER NECK/BURCH PROCEDURE LAPAROSCOPY 51990 Laparoscopy, surgical; urethral suspension for stress Gynecology incontinence LAPAROSCOPY, WITH HYSTEROSCOPY AND DILATION AND CURETTAGE OF HYSTEROSCOPY DILATATION CURETTAGE LAPAROSCOPY 49320 Laparoscopy, abdomen, peritoneum, and omentum, Gynecology UTERUS diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) 58558 Hysteroscopy, surgical; with sampling (biopsy) of endometrium Gynecology and/or polypectomy, with or without D & C LAPAROTOMY, EXPLORATORY LAPAROTOMY EXPLORATORY *49000 Exploratory laparotomy, exploratory celiotomy with or without Colorectal, General, biopsy(s) (separate procedure) Gynecology LAPAROTOMY, EXPLORATORY, WITH LYMPHADENECTOMY, FOR STAGING LAPAROTOMY EXPLORATORY STAGING / LYMPHADENECTOMY *58960 Laparotomy, for staging or restaging of ovarian, tubal, or Gynecology primary peritoneal malignancy (second look), with or without omentectomy, peritoneal washing, biopsy of abdominal and pelvic peritoneum, diaphragmatic assessment with pelvic and limited para-aorti LAPAROTOMY, WITH HYSTERECTOMY IF INDICATED, WITH LAPAROTOMY POSSIBLE HYSTERECTOMY ABDOMINAL TUBES OVARIES *49000 Exploratory laparotomy, exploratory celiotomy with or without Gynecology SALPINGECTOMY AND OOPHORECTOMY IF INDICATED biopsy(s) (separate procedure) *58150 Total abdominal hysterectomy (corpus and cervix), with or Gynecology without removal of tube(s), with or without removal of ovary(s); *58180 Supracervical abdominal hysterectomy (subtotal Gynecology hysterectomy), with or without removal of tube(s), with or without removal of ovary(s) LEEP, USING CO2 LASER LOOP ELECTROSURGICAL EXCISION PROCEDURE W CO2 LASER 57460 Colposcopy of the cervix including upper/adjacent vagina; with Gynecology loop electrode biopsy(s) of the cervix 57522 Conization of cervix, with or without fulguration, with or Gynecology without dilation and curettage, with or without repair; loop electrode excision LOOP ELECTROSURGICAL EXCISION PROCEDURE (LEEP) LOOP ELECTROSURGICAL EXCISION PROCEDURE 57460 Colposcopy of the cervix including upper/adjacent vagina; with Gynecology loop electrode biopsy(s) of the cervix 57461 Colposcopy of the cervix including upper/adjacent vagina; with Gynecology loop electrode conization of the cervix 57522 Conization of cervix, with or without fulguration, with or Gynecology without dilation and curettage, with or without repair; loop electrode excision LYMPHADENECTOMY, FOR STAGING OF LYMPHADENECTOMY STAGING *38562 Limited lymphadenectomy for staging (separate procedure); Gynecology pelvic and para-aortic *38564 Limited lymphadenectomy for staging (separate procedure); Gynecology retroperitoneal (aortic and/or splenic) Page 15 of 20 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - Gynecology and Gynecology Oncology Services New Name Old Name CPT Code Service LYMPHADENECTOMY, INGUINAL REGION, LAPAROSCOPY-ASSISTED DISSECTION GROIN LAPAROSCOPIC ASST 38589 Unlisted laparoscopy procedure, lymphatic system Gynecology LYMPHADENECTOMY, INGUINAL, RADICAL DISSECTION GROIN LYMPH NODES RADICAL 38760 Inguinofemoral lymphadenectomy, superficial, including Gynecology, General Cloquet's node (separate procedure) *38765 Inguinofemoral lymphadenectomy, superficial, in continuity Gynecology, General with pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes (separate procedure) LYMPHADENECTOMY, LAPAROSCOPIC, FOR NEOPLASM STAGING LYMPHADENECTOMY/STAGING LAPAROSCOPY 38589 Unlisted laparoscopy procedure, lymphatic system Gynecology LYMPHADENECTOMY, LAPAROSCOPIC, WITH OMENTECTOMY, FOR LYMPHADENECTOMY OMENTECTOMY LAPAROSCOPY W STAGING 38589 Unlisted laparoscopy procedure, lymphatic system Gynecology NEOPLASM STAGING LYSIS, ADHESIONS, LAPAROSCOPIC LYSIS ADHESIONS LAPAROSCOPY 44180 Laparoscopy, surgical, enterolysis (freeing of intestinal Colorectal, General, ) (separate procedure) Gynecology, Gynecology Oncology 58660 Laparoscopy, surgical; with lysis of adhesions (salpingolysis, Colorectal, General, ovariolysis) (separate procedure) Gynecology, Gynecology Oncology LYSIS, ADHESIONS, LAPAROSCOPIC, WITH LAPAROTOMY IF INDICATED LYSIS ADHESIONS LAPAROSCOPY POSS. LAPAROTOMY *44005 Enterolysis (freeing of intestinal adhesion) (separate procedure) Colorectal, General, Gynecology 44180 Laparoscopy, surgical, enterolysis (freeing of intestinal Colorectal, General, adhesion) (separate procedure) Gynecology 58660 Laparoscopy, surgical; with lysis of adhesions (salpingolysis, Colorectal, General, ovariolysis) (separate procedure) Gynecology LYSIS, ADHESIONS, LAPAROSCOPIC, WITH SALPINGO-OOPHORECTOMY SALPINGO OOPHORECTOMY LAPAROSCOPY(OPERATIVE)WLYSIS 58661 Laparoscopy, surgical; with removal of adnexal structures Gynecology ADHESIONS (partial or total oophorectomy and/or salpingectomy) LYSIS, ADHESIONS, VAGINA LYSIS OF VAGINAL ADHESIONS 56441 Lysis of labial adhesions Gynecology MARSUPIALIZATION, BARTHOLIN'S GLAND MARSUPILIZATION OF BARTHOLIN GLAND 56440 Marsupialization of Bartholin's gland cyst Gynecology MYOMECTOMY, UTERUS, LAPAROSCOPIC MYOMECTOMY (UTERINE) LAPAROSCOPY 58545 Laparoscopy, surgical, myomectomy, excision; 1 to 4 Gynecology intramural myomas with total weight of 250 g or less and/or removal of surface myomas 58546 Laparoscopy, surgical, myomectomy, excision; 5 or more Gynecology intramural myomas and/or intramural myomas with total weight greater than 250 g 58674 Laparoscopy, surgical, ablation of (s) including Gynecology intraoperative guidance and monitoring, radiofrequency MYOMECTOMY, UTERUS, OPEN MYOMECTOMY (UTERINE) OPEN *58140 Myomectomy, excision of fibroid tumor(s) of uterus, 1 to 4 Gynecology intramural (s) with total weight of 250 g or less and/or removal of surface myomas; abdominal approach 58145 Myomectomy, excision of fibroid tumor(s) of uterus, 1 to 4 Gynecology intramural myoma(s) with total weight of 250 g or less and/or removal of surface myomas; vaginal approach *58146 Myomectomy, excision of fibroid tumor(s) of uterus, 5 or more Gynecology intramural myomas and/or intramural myomas with total weight greater than 250 g, abdominal approach OMENTECTOMY OMENTECTOMY *49255 Omentectomy, epiploectomy, resection of omentum (separate Gynecology procedure) PERINEOPLASTY Gynecology

Page 16 of 20 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - Gynecology and Gynecology Oncology Services New Name Old Name CPT Code Service PLICATION, LIGAMENT, UTEROSACRAL UTEROSACRAL PLICATION 57283 Colpopexy, vaginal; intra-peritoneal approach (uterosacral, Gynecology Oncology, levator myorrhaphy) Gynecology REANASTOMOSIS, FALLOPIAN TUBE, BILATERAL, ROBOT-ASSISTED, ANASTOMOSIS TUBAL W XI ROBOTICS 58673 Laparoscopy, surgical; with salpingostomy (salpingoneostomy) Gynecology Robotics LAPAROSCOPIC, USING XI REMOVAL, ECTOPIC PREGNANCY REMOVAL ECTOPIC PREGNANCY *59120 Surgical treatment of ectopic pregnancy; tubal or ovarian, Gynecology requiring salpingectomy and/or oophorectomy, abdominal or vaginal approach *59121 Surgical treatment of ectopic pregnancy; tubal or ovarian, Gynecology without salpingectomy and/or oophorectomy *59130 Surgical treatment of ectopic pregnancy; abdominal pregnancy Gynecology *59135 Surgical treatment of ectopic pregnancy; interstitial, uterine Gynecology pregnancy requiring total hysterectomy *59136 Surgical treatment of ectopic pregnancy; interstitial, uterine Gynecology pregnancy with partial resection of uterus *59140 Surgical treatment of ectopic pregnancy; cervical, with Gynecology evacuation 59150 Laparoscopic treatment of ectopic pregnancy; without Gynecology salpingectomy and/or oophorectomy 59151 Laparoscopic treatment of ectopic pregnancy; with Gynecology salpingectomy and/or oophorectomy REMOVAL, FOREIGN BODY REMOVAL FOREIGN BODY 10120 Incision and removal of foreign body, subcutaneous tissues; General, Colorectal, simple Orthopedics, Dental Surgery, Plastics, Gynecology, Podiatry, Urology, Thoracic 10121 Incision and removal of foreign body, subcutaneous tissues; General, Colorectal, complicated Orthopedics, Dental Surgery, Plastics, Gynecology, Podiatry, Urology, Thoracic REPAIR, CYSTOCELE Gynecology REPAIR, DEFECT, PARAVAGINAL, VAGINAL APPROACH REPAIR PARA VAGINAL VAGINAL APPROACH 57285 Paravaginal defect repair (including repair of cystocele, if Gynecology performed); vaginal approach REPAIR, ENTEROCELE Gynecology REPAIR, ENTEROCELE, WITH VAGINAL VAULT SUSPENSION REPAIR ENTEROCELE W SUSPENSION VAGINAL VAULT 57265 Combined anteroposterior colporrhaphy, including Gynecology cystourethroscopy, when performed; with enterocele repair 57268 Repair of enterocele, vaginal approach (separate procedure) Gynecology *57270 Repair of enterocele, abdominal approach (separate Gynecology procedure) *57280 Colpopexy, abdominal approach Gynecology 57282 Colpopexy, vaginal; extra-peritoneal approach (sacrospinous, Gynecology iliococcygeus) REPAIR, RECTOCELE Gynecology REPAIR, VAGINAL INTROITUS Gynecology REVERSAL, FALLOPIAN TUBE OCCLUSION REVERSAL FALLOPIAN TUBAL OCCLUSION *58750 Tubotubal anastomosis Gynecology REVISION OR REMOVAL, MESH, VAGINA REVISION/REMOVAL VAGINAL WALL MESH 57295 Revision (including removal) of prosthetic vaginal graft; vaginal Gynecology approach *57296 Revision (including removal) of prosthetic vaginal graft; open Gynecology abdominal approach Page 17 of 20 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - Gynecology and Gynecology Oncology Services New Name Old Name CPT Code Service REVISION OR REMOVAL, MESH, VAGINA REVISION/REMOVAL VAGINAL WALL MESH 57426 Revision (including removal) of prosthetic vaginal graft, Gynecology laparoscopic approach REVISION OR REMOVAL, MESH, VAGINAL WALL, ANTERIOR REVISION/EXCISION ANTERIOR VAGINAL WALL MESH 57295 Revision (including removal) of prosthetic vaginal graft; vaginal Gynecology approach *57296 Revision (including removal) of prosthetic vaginal graft; open Gynecology abdominal approach 57426 Revision (including removal) of prosthetic vaginal graft, Gynecology laparoscopic approach REVISION OR REMOVAL, MESH, VAGINAL WALL, POSTERIOR REVISION/EXCISION POSTERIOR VAGINAL WALL MESH 57295 Revision (including removal) of prosthetic vaginal graft; vaginal Gynecology approach *57296 Revision (including removal) of prosthetic vaginal graft; open Gynecology abdominal approach 57426 Revision (including removal) of prosthetic vaginal graft, Gynecology laparoscopic approach SACROCOLPOPEXY, ROBOT-ASSISTED, USING XI SACROCOLPOPEXY W XI ROBOTIC 57425 Laparoscopy, surgical, colpopexy (suspension of vaginal apex) Gynecology Robotics SALPINGO-OOPHORECTOMY, BILATERAL, ROBOT-ASSISTED, USING XI SALPINGO-OOPHORECTOMY W XI ROBOTICS BILATERAL 58661 Laparoscopy, surgical; with removal of adnexal structures Gynecology Robotics (partial or total oophorectomy and/or salpingectomy) SALPINGO-OOPHORECTOMY, LAPAROSCOPIC SALPINGO-OOPHORECTOMY LAPAROSCOPY (OPERATIVE) 58661 Laparoscopy, surgical; with removal of adnexal structures Gynecology (partial or total oophorectomy and/or salpingectomy) SALPINGO-OOPHORECTOMY, OPEN SALPINGO-OOPHORECTOMY OPEN *58720 Salpingo-oophorectomy, complete or partial, unilateral or Gynecology bilateral (separate procedure) SURGICAL PROCEDURE, LAPAROSCOPIC LAPAROSCOPY OPERATIVE PER MD Gynecology Oncology, Gynecology, General SUSPENSION, VAGINAL VAULT, WITHOUT USING MESH SUSPENSION VAGINAL VAULT W/O MESH *57280 Colpopexy, abdominal approach Gynecology 57282 Colpopexy, vaginal; extra-peritoneal approach (sacrospinous, Gynecology iliococcygeus) 57283 Colpopexy, vaginal; intra-peritoneal approach (uterosacral, Gynecology levator myorrhaphy) 57425 Laparoscopy, surgical, colpopexy (suspension of vaginal apex) Gynecology SUSPENSION, VAGINAL VAULT, WITHOUT USING MESH, WITH SUSPENSION VAGINAL VAULT W/O MESH W CYSTOSCOPY 52000 Cystourethroscopy (separate procedure) Gynecology CYSTOSCOPY *57280 Colpopexy, abdominal approach Gynecology 57282 Colpopexy, vaginal; extra-peritoneal approach (sacrospinous, Gynecology iliococcygeus) 57283 Colpopexy, vaginal; intra-peritoneal approach (uterosacral, Gynecology levator myorrhaphy) 57425 Laparoscopy, surgical, colpopexy (suspension of vaginal apex) Gynecology SUSPENSION, VAGINAL VAULT, WITHOUT USING MESH, WITH URETHRAL SUSPENSION VAGINAL VAULT W/O MESH W SUBURETHERAL SLING *57280 Colpopexy, abdominal approach Gynecology SLING CREATION 57282 Colpopexy, vaginal; extra-peritoneal approach (sacrospinous, Gynecology iliococcygeus) 57283 Colpopexy, vaginal; intra-peritoneal approach (uterosacral, Gynecology levator myorrhaphy) 57288 Sling operation for stress incontinence (eg, fascia or synthetic) Gynecology 57425 Laparoscopy, surgical, colpopexy (suspension of vaginal apex) Gynecology

Page 18 of 20 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - Gynecology and Gynecology Oncology Services New Name Old Name CPT Code Service SUSPENSION, VAGINAL VAULT, WITHOUT USING MESH, WITH URETHRAL SUSPENSION VAGINAL VAULT W/O MESH W SLING W CYSTOSCOPY 51992 Laparoscopy, surgical; sling operation for stress incontinence Gynecology SLING CREATION AND CYSTOSCOPY (eg, fascia or synthetic) 52000 Cystourethroscopy (separate procedure) Gynecology *57280 Colpopexy, abdominal approach Gynecology 57282 Colpopexy, vaginal; extra-peritoneal approach (sacrospinous, Gynecology iliococcygeus) 57283 Colpopexy, vaginal; intra-peritoneal approach (uterosacral, Gynecology levator myorrhaphy) 57288 Sling operation for stress incontinence (eg, fascia or synthetic) Gynecology 57425 Laparoscopy, surgical, colpopexy (suspension of vaginal apex) Gynecology SUTURE REPAIR, PERINEUM Gynecology TRACHELECTOMY, VAGINAL APPROACH TRACHELECTOMY/CERVICECTOMY VAGINAL 57530 Trachelectomy (cervicectomy), amputation of cervix (separate Gynecology procedure) ULTRASOUND, FETUS, IN LABOR AND DELIVERY ULTRASOUND IN L&D 76815 Ultrasound, pregnant uterus, real time with image Gynecology documentation, limited (eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses 76816 Ultrasound, pregnant uterus, real time with image Gynecology documentation, follow-up (eg, re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ system(s) suspected or confirmed to be abnormal on a prev VAGINECTOMY VAGINECTOMY (LEFORT PROCEDURE) 57120 Colpocleisis (Le Fort type) Gynecology VAGINECTOMY, WITH COLPOCLEISIS, SUBURETHRAL SLING CREATION, VAGINECTOMY W COLPOCLEISIS W INSERTION SLING W CYSTOSCOPY 52000 Cystourethroscopy (separate procedure) Gynecology AND CYSTOSCOPY 57106 Vaginectomy, partial removal of vaginal wall; Gynecology *57110 Vaginectomy, complete removal of vaginal wall; Gynecology 57120 Colpocleisis (Le Fort type) Gynecology 57288 Sling operation for stress incontinence (eg, fascia or synthetic) Gynecology VAGINECTOMY, WITH LE FORT PARTIAL COLPOCLEISIS VAGINECTOMY (LEFORT PROCEDURE) W COLPOCLEISIS 57106 Vaginectomy, partial removal of vaginal wall; Gynecology 57120 Colpocleisis (Le Fort type) Gynecology , VAGINAL VESTIBULECTOMY VAGINAL 56620 simple; partial Gynecology 56625 Vulvectomy simple; complete Gynecology VULVECTOMY, PARTIAL, SIMPLE VULVECTOMY PARTIAL/SIMPLE 56620 Vulvectomy simple; partial Gynecology VULVECTOMY, RADICAL VULVECTOMY RADICAL *56630 Vulvectomy, radical, partial; Gynecology *56631 Vulvectomy, radical, partial; with unilateral inguinofemoral Gynecology lymphadenectomy *56632 Vulvectomy, radical, partial; with bilateral inguinofemoral Gynecology lymphadenectomy *56633 Vulvectomy, radical, complete; Gynecology *56634 Vulvectomy, radical, complete; with unilateral inguinofemoral Gynecology lymphadenectomy *56637 Vulvectomy, radical, complete; with bilateral inguinofemoral Gynecology lymphadenectomy *56640 Vulvectomy, radical, complete, with inguinofemoral, iliac, and Gynecology pelvic lymphadenectomy

Page 19 of 20 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - Gynecology and Gynecology Oncology Services New Name Old Name CPT Code Service VULVECTOMY, RADICAL, WITH BILATERAL INGUINAL LYMPHADENECTOMY VULVECTOMY RADICAL W DISSECTION LYMPH NODES GROIN BILATERAL *56632 Vulvectomy, radical, partial; with bilateral inguinofemoral Gynecology lymphadenectomy *56637 Vulvectomy, radical, complete; with bilateral inguinofemoral Gynecology lymphadenectomy VULVECTOMY, SIMPLE, WITH EXCISION OF VULVAR LESION EXCISION/BIOSPY LESION VULVA W PARTIAL VULVECTOMY 11420 Excision, benign lesion including margins, except skin tag Gynecology (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less 11421 Excision, benign lesion including margins, except skin tag Gynecology (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm 11422 Excision, benign lesion including margins, except skin tag Gynecology (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm 11423 Excision, benign lesion including margins, except skin tag Gynecology (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm 11424 Excision, benign lesion including margins, except skin tag Gynecology (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm 11426 Excision, benign lesion including margins, except skin tag Gynecology (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm 11620 Excision, malignant lesion including margins, scalp, neck, Gynecology hands, feet, genitalia; excised diameter 0.5 cm or less 11621 Excision, malignant lesion including margins, scalp, neck, Gynecology hands, feet, genitalia; excised diameter 0.6 to 1.0 cm 11622 Excision, malignant lesion including margins, scalp, neck, Gynecology hands, feet, genitalia; excised diameter 1.1 to 2.0 cm 11623 Excision, malignant lesion including margins, scalp, neck, Gynecology hands, feet, genitalia; excised diameter 2.1 to 3.0 cm 11624 Excision, malignant lesion including margins, scalp, neck, Gynecology hands, feet, genitalia; excised diameter 3.1 to 4.0 cm 11626 Excision, malignant lesion including margins, scalp, neck, Gynecology hands, feet, genitalia; excised diameter over 4.0 cm 56620 Vulvectomy simple; partial Gynecology 56625 Vulvectomy simple; complete Gynecology

Page 20 of 20 * Indicates Inpatient only CPT Code/Procedure