Lynn Posted Mon 13th of March, 2017 08:56:54 AM
One of our gyn docs performed a laparoscopic oophorectomy and the other did laparoscopic omentectomy and staging biopsies. What codes do you think are appropriate for this case?
SuperCoder Answered Tue 14th of March, 2017 03:39:36 AM
Please send some more information for us to provide the most appropriate codes. Thank you.
Lynn Posted Tue 14th of March, 2017 09:18:46 AM
Exam under anesthesia revealed a pelvic mass high at the vaginal apex. A Foley catheter was placed in the bladder and a sponge stick was placed in the vagina.
The base of the umbilicus was everted and infiltrated with 0.25% Marcaine. A 12 millimeter incision was made. The Veress needle was passed through this incision, and the hanging column test passed. The abdomen was insufflated under low opening pressure, initially up to 22 millimeters of mercury, which was then lowered to 15 millimeters of mercury after all ports were placed. A 12 millimeter port was placed at the umbilicus and 5 millimeter ports were placed in the bilateral lower quadrants and in the right abdomen midway between the right lower quadrant and umbilical port. All entry sites were atraumatic. Combined ultrasonic and advanced bipolar energy were used throughout the procedure.
Pelvic washings were obtained. The right adnexal torsion was reduced. The peritoneum lateral to the right ovarian vessels was incised parallel to the vessels up above the level of the pelvic brim. The right ovarian vessels were reflected medially. The right ureter was seen and was well away. The right ovarian vessels were desiccated and divided. The peritoneum medial and lateral to these vessels were divided up to the level at which the ovary was mildly adherent to the remnant of the right round ligament. The tube and ovary were free and placed into an EndoCatch bag and removed through the midline port. A small amount of brown tinged serous fluid was drained in a contained fashion within the bag to allow the cyst to be removed and sent to Pathology. No spillage of any bag contents occurred within the abdomen.
The midline port was replaced. The epiploica adherent to the left pelvic brim and around the left ovary were taken down with ultrasonic energy. The left ovary was tractioned medially and the peritoneum lateral to it was incised cephalad and caudad. The minor adhesions of this adnexa to the remnant of the left round ligament were divided and the peritoneum was then divided medial to the left adnexa in order to skeletonize the left ovarian vessels. The left ureter was noted to be well away and the left ovarian vessels were desiccated and divided, and excellent hemostasis was noted. This specimen was placed into separate EndoCatch bag and removed from the abdomen and sent to Pathology for permanent section.
At this point in time, the frozen section pathology returned consistent with serous borderline tumor and Dr. McLean was called to the OR. While she was en route, peritoneal biopsies were taken with cold scissors from the right and left upper and lower pericolic gutters, the right and left pelvis, the posterior cul-de-sac and the bladder peritoneum per her direction. These specimens were sent to Pathology separately. The peritoneal edges of these incisions were made hemostatic with advanced bipolar energy. At this point, she had arrived in the OR and took over the remainder of the staging portion of the procedure. Please see her separately dictated operative report.
After all surgery was completed, the abdomen and pelvis were copiously irrigated. Irrigant fluid was evacuated and a low-pressure check confirmed hemostasis at all operative pedicles. The pressure was returned to 15 millimeters of mercury and the midline fascia was closed with 2 interrupted 0 Vicryl sutures using the Endoclose device. The lateral ports were removed under direct visualization. The abdomen was completely desufflated and the final port was removed. The skin at all incisions was closed with 4-0 Monocryl using subcuticular sutures and then covered with sterile dressings after infiltration with additional 0.25% Marcaine.
Biopsies taken by other doctor: they also proceeded to take upper abdominal paracolic gutter biopsies. Additionally, they were advised to take a bladder peritoneal biopsy and a posterior cul-de-sac biopsy.
SuperCoder Answered Thu 16th of March, 2017 04:16:22 AM
The appropriate codes for the above procedure will be 58661, 49329 and 49321. As per NCCI edit CPT 49321 bundles to 58661, however modifier 59 can be appended to rule out bundling. Thank you.