Question: The ob/gyn performed a diagnostic laparoscopy, left ovarian cystectomy, right adnexal cystectomy, endometrial biopsy and pelvic washing. The physician diagnosed the patient with an ovarian cyst. Which of these procedures is bundled, and which can be reported separately?
Answer: You should bill the cystectomy performed via the laparoscope with 58661 (Laparoscopy, surgical; with removal of adnexal structures [partial or total oophorectomy and/or salpingectomy]) because the cysts were located in two different sites. The physician likely removed part of the adnexal structure along with the cysts.
If the ob/gyn did not remove part of the adnexal structure or ovaries and this was a simple cyst removal on both sides, you should report 58662 ( with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method). In either case, you should link the procedure code to 620.x for the ovarian cyst.
Although CCI bundles the pelvic washing into the diagnostic laparoscopy, you may code the endometrial biopsy with 58100-51 (Endometrial sampling [biopsy] with or without endocervical sampling [biopsy], without cervical dilation, any method [separate procedure]; multiple procedures). Instead of linking this procedure to the 620.x diagnosis, however, you should connect it to the diagnosis that represents the reason you did the procedure, or to the biopsy result if you are waiting for the pathology report before billing.