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Posted By Dorine on 02-01-2018, 18:41:27 in Ob-Gyn
Hello Ob-Gyn Group,

My doctor did a procedure called BLT Application and I am unsure if it would be coded as an unlisted code or if there is a code for this procedure, this was done in the office.

Dx: Vestibulitis of Vagina

Procedure: Patient was taken to exam room, and placed in lithotomy position. Vestibule visualized. Approximately 10ml of 20% Benzocaine/8%Lidocaine/8% Tetracaine applied to vestibule. Good blanching noted after application, with numbness. No allergic reaction to medication noted. Post-application instructions given. Patient tolerated application well.
Thank you in advance for your help.

Comments (4)
Posted By Dorine on 02-02-2018, 17:52:01
Thank you again Melanie, I do so appreciate your expertise advise. Have a great weekend!
Posted By Melanie Witt on 02-02-2018, 17:47:14
The T codes are for use primarily by Medicaid State agencies to identify items for which there are no permanent national codes and for which codes are necessary to meet a national Medicaid program operating need. T codes may be also used by private insurance programs but they are not payable by Medicare. So if you are billing Medicaid for this BLT application T1503 should get it paid, but most likely not a commercial payer without some footwork on your part. This would NOT be considered a 99214 E/M service for just this application in any case in my opinion as it is not moderate complexity of medical decision making and there is no counseling that is going on to dominate the visit. Again, CPT is not geared for this type of medication application but as an alternative you could try the unlisted code 17999 (which will also be hard to get reimbursement for without submitting documentation). Good luck.
Posted By Dorine on 02-02-2018, 16:25:20
Physician has additional question please:

Melanie, my physician submitted CPT T1503 and would like to bill that code, he says he already did the E&M last week and then scheduled her to come back for the application only. Could this code be considered to capture the administration of medication only? if not, since she is established would this be considered as a 99214?
Posted By Melanie Witt on 02-02-2018, 16:14:18
Benzocaine; lidocaine; tetracaine (BLT cream) is a combination of topical anesthetics used in application to accessible mucous membrane except the eyes. These products are used for topical anesthesia and mild pain control. Per a CPT instruction found just before code 17000 "for initiation or follow-up care of topical chemotherapy, see appropriate office visits." Therefore, topical applications by the provider would be considered part of the E/M service, especially as this was not used to destroy lesions, but rather to control pain, but you can bill for the cream separately (or at least try to) as a supply. As it is topical you will not find a J code for it, but report the NDC # on the packaging along with 99070.
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