CPT Code 56420 Incision Procedures on the Vulva, Perineum, and Introitus

Gynecological billing involves precise coding for both routine and surgical procedures. CPT code 56420 is used explicitly for the treatment of a Bartholin's gland abscess, a common yet painful condition. Due to the procedure's specific nature and complexity, accurate coding and documentation are essential for timely reimbursement.

In this article, we'll explain the code's description, scenarios where it is applicable, relevant modifiers, and critical billing and reimbursement guidelines, all aligned with the latest 2025 AAPC updates, to help you submit accurate claims and receive timely payment.

CPT Code 56420 – Description

The official definition of CPT code 56420 is: "Incision and drainage of Bartholin's gland abscess."

This code describes the surgical procedure to treat an infected and swollen Bartholin's gland. The procedure involves making an incision into the abscess to release the pus and fluid. Unlike a simple abscess drainage, this code often includes the placement of a Word catheter to keep the incision open and allow for continued drainage, which helps the gland heal properly and reduces the risk of recurrence.

This procedure is typically performed in an office setting and is considered more complex than a simple incision and drainage (such as CPT 56405). The additional complexity arises from the need for specialized surgical instruments and the placement and management of the catheter.

Scenarios Where CPT Code 56420 is Applicable

You would bill CPT code 56420 in the following situations:

• Treatment of an Infected Bartholin's Cyst: When a patient presents with a painful, infected, and swollen lump in the Bartholin's gland near the vaginal opening.
  • Example: A patient has a large, tender mass on her vulva. The physician diagnoses a Bartholin's gland abscess and performs an in-office incision and drainage with the placement of a Word catheter to treat the infection.
• Drainage of a Recurrent Abscess: This code is used even if the patient has had previous issues with the gland, as each abscess is considered a new event requiring surgical intervention.

Applicable Modifiers for CPT Code 56420

The following modifiers may be used with CPT code 56420 when needed:

• Modifier 25 indicates that a significant, separately identifiable evaluation and management (E/M) service was performed on the same day as the procedure. This would be used if the provider performed a full E/M visit to address a separate issue on the same day.
• Modifier 54 specifies that the surgeon performed the surgical procedure only, and a different provider will handle the patient's postoperative care.
• Modifier 55 indicates that the physician only provided the postoperative management.
• Modifier 59 identifies a distinct procedural service. It would be used if another procedure were performed in a different anatomical area on the same day, to prevent billing denials for duplicate services.

CPT Code 56420 – Billing & Reimbursement

To ensure proper reimbursement for CPT code 56420, follow these key steps, which are crucial for 2025 AAPC compliance:

• Justify Medical Necessity: Your documentation must clearly describe the abscess, its location, size, and symptoms (e.g., pain, swelling, pus) that necessitated the procedure. It should specifically state that it is a Bartholin's gland abscess.
• Use Accurate ICD-10 Codes: CPT 56420 should always be paired with the correct diagnosis code. The primary diagnosis is typically:
  • N75.1 – Abscess of Bartholin's gland.
• Understand Global Period and Bundling Rules: This procedure is part of a global surgical package, which includes pre-operative and postoperative care. For in-office procedures, the global period is typically 10 days, meaning separate E&M services for related care within that period may not be billable. The insertion and removal of the Word catheter are included in this global fee and cannot be billed separately.
• Detailed Documentation: The operative note should be thorough, detailing the location, the incision, the drainage, and the size and type of catheter used. The removal of the catheter should also be noted in the patient's record.
• Reimbursement Scenarios: Reimbursement rates depend on the payer and the place of service. Always verify the payer's fee schedule and policies to understand the global period and any bundling rules that may apply.

Why Choose BillingFreedom for OBGYN Billing?

BillingFreedom offers unmatched expertise in OBGYN billing services, a highly specialized yet often misunderstood area of medical billing. Our certified billing and coding specialists have a deep understanding of gynecological documentation requirements, ensuring every claim is accurate, compliant, and optimized for maximum reimbursement. By eliminating costly errors and streamlining claim submissions, we help practices reduce denials and maintain seamless revenue cycles.

Our proven approach at BillingFreedom delivers 100% accuracy and reliable results, leading to significant financial improvements for OBGYN providers. We manage the complexities of medical billing, allowing you to focus entirely on delivering high-quality patient care. At the same time, we ensure your services are coded, documented, and reimbursed with the highest level of professionalism.

For more details about our exceptional OBGYN medical billing services, please don't hesitate to contact us via email at info@billingfreedom.com or call us at +1 (855) 415-3472. 

Your financial tranquility is our priority!