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node biopsy

Lynn Posted Wed 17th of August, 2016 07:58:06 AM
Da Vinci-assisted laparoscopy, paraaortic node dissection, and resection of paraaortic cystic mass, biopsy and resection of pelvic peritoneal nodule above vaginal apex. Not sure if to use an unlisted code . This is for unstaged cervical cancer
SuperCoder Answered Thu 18th of August, 2016 09:05:53 AM

Please provide more details of procedure for appropriate answer.

Lynn Posted Thu 18th of August, 2016 11:37:19 AM
During the laparoscopic portion of the operation, she was noted to have a multilobular cystic mass in the retroperitoneum near the paraaortic nodes in addition to a yellow tan serosal nodule in the cul-de-sac near the apex of the vagina. The biopsy on the vaginal apex nodule was submitted for frozen section and the paraaortic and retroperitoneal cystic nodules were submitted for permanent pathology. The frozen section returned with metastatic carcinoma. At this point, it was determined that she had intraperitoneal metastatic disease and the radical parametrectomy was no longer the correct treatment. Not sure what codes to use....unlisted?
SuperCoder Answered Fri 19th of August, 2016 10:13:05 AM

As per the documentation, approach of surgeon is not clear. If surgeon has performed procedure through digestive system the appropriate code is 49321 and if approach is through vagina then it will coded as unlisted.

Lynn Posted Mon 22nd of August, 2016 10:32:00 AM
dr is saying he This was a laparoscopic para-aortic node dissection and resection of an intraperitoneal malignant implant. This RVU amount is very low. can you help ?
SuperCoder Answered Tue 23rd of August, 2016 10:02:07 AM

I agree that RVU value of the code is very less. This was just a suggestion in case surgeon's approach was through digestive system. Since, the provided documentation does not clear the approach of the procedure,so I am assuming the approach through vagina,hence there is no specific code for the above mentioned procedure, use unlisted code i.e 58999. Do not forget to attach the operative report with the claim form to avoid deduction in payment.

Lynn Posted Wed 24th of August, 2016 07:20:47 AM
It is abdominal approach. Sorry about that
SuperCoder Answered Thu 25th of August, 2016 10:04:00 AM

If the surgeon approach is via abdomen than appropriate code will be 49329 i.e unlisted. Do not forget to attach the operative report with the claim form to avoid deduction in payment.

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