Topic

• Introduction
• Indications
• Contraindications
• Procedure
• Coding Information

Table(s)

• Differential Diagnosis

Figure(s)

• Removal of the Polyp Using Traction

• Cervical polyps are pedunculated tumors that commonly arise from the mucosa of the endocervical canal. The cause of most polyps is unknown, but they are associated with increasing age, inflammation, trauma, and pregnancy.
• The histology of cervical polyps is similar to that of the endocervical canal, with a single tall columnar cell layer and occasional cervical glands. If a polyp is discovered after an atypical Pap smear, send the polyp for pathologic study, especially if it contains any acetowhite epithelium. Patients on tamoxifen therapy have a very high association of cervical polyps with endometrial polyps and probably should be evaluated with dilatation and curettage.
• Differential diagnosis for cervical polyps is shown in Table 36-1. Because most polyps are benign, they may be removed or observed on routine exams.
• After removal of a polyp, the patient should avoid sexual intercourse, douching, and tampon use for several days. Perform a follow-up exam in 1–2 wks to check for problems, if desired. If active bleeding occurs, the patient should be seen immediately. An exam to check for regrowth should be performed at routine gynecologic visits. Unfortunately, recurrence is common.

Removal of polyps is usually indicated to prevent irritation, vaginal discharge, and bleeding.

Because the cervix is highly vascularized during pregnancy, polyps should be observed if they are stable and appear benign. They should be removed only if they are causing bleeding.

• Perform standard gynecologic exam. Gently grasp polyp with ring forceps, apply slight traction, and twist repeatedly until it falls off (Fig. 36-1). If a significant amount of the base of the polyp remains, it may be scraped off with a curette.
• Alternatively, a small polyp may be scraped off in its entirety with a sharp curette or biopsied off with Tischler biopsy forceps. Bleeding is usually self-limited but can be controlled with pressure, Monsel's solution, or cautery.
• Pitfall: Be sure to identify the location of the base of the polyp to exclude the possibility of an endometrial polyp, which may produce extensive bleeding. If the pedicle extends too deeply to be easily visualized, a Kogan endocervical speculum and colposcopic magnification are often helpful.
• Pitfall: If there are multiple polyps, irregular bleeding, or ongoing tamoxifen therapy is noted, it may be prudent to remove polyps while performing dilatation and curettage.

There is no separate CPT code for cervical polyp removal. Some practitioners report polypectomy with 57500 (cervix uteri biopsy) or 57505 (endocervical curettage). If a colposcope is used to identify the polyp base, 57452 can be used to report services.