# Ovarian cyst removal



## Diana29 (Jun 21, 2019)

Hello, I could use some help with this one. I came up with 49322, 58661-LT, 58925-LT. Are my codes correct? Thank you!


PROCEDURES: 　Examination under anesthesia, diagnostic laparoscopy,
laparoscopic left salpingo-oophorectomy and mini laparotomy to remove
the cyst as well as cyst drainage.




NARRATIVE: 　The patient was taken to the OR and after general
anesthesia was introduced, and examination under anesthesia was done
with the findings as above. 　She was then prepped and draped in a
sterile manner. 　A sponge stick was placed in the vagina just for
manipulation of the uterus if needed and then attention was turned to
the abdomen where because of the size of the mass, a 5 mm incision
was made in the right lower quadrant. 　The Veress needle was placed,
tested with saline. 　The abdomen was insufflated. 　The Veress needle
was removed and then a 5 mm 0 degree scope was placed through the
Visiport and through this incision, the large mass was seen. 　A
second 12 mm port was then placed in the left lower quadrant under
direct visualization as was an additional 5-mm port in the right
upper quadrant. 　We could easily see that the infundibulopelvic
ligament on the left side was torsed several times and this as well
as the broad ligament and uteroovarian ligament were ligated using
the EnSeal easily and hemostasis was assured using cautery. 　At this
point, it was clear that the uterus and the left tube and ovary were
normal, and there were some adhesions of the omentum to the anterior
abdominal wall and so these were lysed using monopolar cautery.
Then, successively sticking areas of the cystic mass, we drained over
1500 mL of the mass to decrease its size to try to be able to remove
it through an EndoCatch bag; however, it was never able to be placed
into the bag because it still remained too large. 　Therefore, after
grasping the cyst laparoscopically, I extended the left lower
quadrant incision through the skin and subcutaneous tissue and the
fascia in order to be able to bring the cyst up to the surface and
further drain it to be able to remove it from the patient's abdominal
cavity. 　This whole procedure including draining to the cyst lasted
more than 60 minutes and extended the time of the operation
extensively. 　Once the cyst was removed, hemostasis was assured. 　The
abdominal wall was closed in a mass closure, the subcutaneous tissue
was closed with interrupted 2-0 sutures and then all the skin
incisions were closed with 3-0 Monocryl. 　The patient was awakened,
extubated, and taken to the recovery room in stable condition after
all counts were correct.


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## tonyabcarr (Jun 25, 2019)

49322, 58661-LT,59  The 58925 is for open abdominal incisions not laparoscopic.  Payers may deny the 58661 since 49322 is more extensive.  You could also try:  58661-LT, 58662-59


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