Cindy Posted Tue 14th of February, 2017 17:48:05 PM
Provider asking how best to code for ovarian cystectomies & biopsies with reconstruction/suspension of ovaries, bilateral. Provider has coded the other surgical procedures as follows: 44238 Discoid Resection of Endometriosis on Colon; 50949 Ureterolysis; 58570 TLH Uterus 250 G or less; 58662 Laparoscopy Excise Lesions.
Here are descriptions from Op Report:
Pre-operative Diagnosis:ENDOMETROISIS, VAGINAL PAIN, STRESS INCONTINENCE
Post-operative Diagnosis: same plus bilateral ovarian cysts c/w endometriomas, retroperitoneal fibrosis, and superficial rectal endometriosis.
Procedure: Procedure(s) and Anesthesia Type:
* ROBOTIC LAPAROSCOPIC HYSTERECTOMY WITH BILATERAL SALPINGECTOMY, EXCISION OF ENDOMETRIOSIS, BILATERAL OVARIAN SUSPENSION, BILATERAL OVARIAN CYSTECTOMY, LEFT URETEROLYSiS, PARTIAL THICKNESS BOWEL RESECTION, CYSTOSCOPY - General
2 endometriomas of left ovary approximately 1-2cm each, adhesions of the left tube and ovary to the left pelvic sidewall, right ovarian cyst with bloody fluid question endometrioma vs hemorrhagic corpus luteum. Deeply infiltrating endometriosis of the left uterosacral ligament with the rectum adherent to it and posterior cervix. Superficial endometriosis of bowel wall at the left uterosacral. Left ureter pulled medially into the fibrotic tissue of the endometriosis of the left uterosacral. Large boggy uterus c/w adenomyosis.
SuperCoder Answered Wed 15th of February, 2017 02:34:50 AM
Hi as per above details the appropriate cpt code would be 58571, Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) and 58662, Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method.The ureterolysis was performed for surgical access, not a separate medically indicated procedure and as such would be not reimbursed separately.
Cindy Posted Wed 15th of February, 2017 23:02:31 PM
Can the bilateral ovarian cystectomies and suspensions be coded/billed as additional procedures? Or are you indicating that they are included in the CPT coding you provided above?
SuperCoder Answered Thu 16th of February, 2017 23:57:29 PM
In 58662 procedure, the provider destroys or excises lesions, tumors, or cysts found on the ovary, around the bladder, uterus, rectum, and or on the peritoneum. The provider performs this procedure with a laparoscope.
Report code 58662 if the provider excises an ovarian cyst, but does not remove any of the ovaries in the process.
If the pathology report indicates presence of ovarian tissue in the specimen, the procedure becomes a partial oophorectomy and the code 58661, Laparoscopy, surgical; with removal of adnexal structures, partial or total oophorectomy, and or salpingectomy, would be reported instead.
If the provider will remove endometrial implants as well as an ovarian cyst during the same surgery. The code 58662 represents all the work in that case. If the provider documents significant additional work during this more extensive surgery, the addition of modifier 22, Increased procedural service requiring work substantially greater than typically required, may be an option.
For some private-pay patients, be sure to add modifier 50 (Bilateral procedure) because CPT considers 58661 a unilateral procedure. But Medicare and other commercial payers disagree and do not accept modifier 50 with this code. Also, be sure to check the op note and path report for details because 58662 has a higher relative value unit (RVU).