# Excision of complex left adnexal mass



## nelamaria (Oct 20, 2010)

my provider did a excision of complex left adnexal mass during a C-Section and Tubal ligation procedure.

I know it has the word complex and in the report the mass was extensive including the omentum and the bowel.

I was thinking of the 59515,58611 for c-section and tubal, but can I use the 58740 or the 58140 or it's inclusive in the main procedure.

Thank you for all your input.

Nelamaria


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## preserene (Oct 20, 2010)

You said it was an EXCISION of complex adenxal mass including omentum and small bowel. I think we didn't get avery clear picture
Well, was there a perforation small bowel or resection of small bowel and anastomosis or just an adhesiolysis of omentum and small bowel AND an excision of the complex mass?
.
If none of the above but excision of the complex mass( we do not know what THAT MASS WAS and so it amounts to tumor or cyst(s) or endometriomas. 
So in addtion to your Cesar Code and Sterilization Code, we can use 49203 / 49204,49205.

If excision of that mass and massive adhesiolysis/ omendectomy (not small boew procedures), adhesiolysisan domendectomy can be reported appending with modifier 59/ 22 as it merits.

If resection s.bowel , on colon and so on please see the notes below 49205


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## nelamaria (Oct 20, 2010)

*left adnexal mass*

no there was no punchure or rupture to the bowel. The dr. mention that the uterus was repaired in two layerslf # 1 chromic. The uterus and right tube and ovary appeeared to be withing the normal limits. the entire left adnexa of the pt was adhesed with omentum and bowel, etc. all these adhesions were lysed as best as possible, identifying a complex hemorrhagic left adnexal mass, which may or may not have encompassed the left tube/
in addition it was difficult to identify the tube even arising from the fundus of the uterus , area  was quite edematous compared to the right side.

hope this will make a more clear picture, again thanks for your input.


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## preserene (Oct 20, 2010)

The scenario tells me that there was a Chocolate Cyst of the left ovary (ie endometriosis of the left ovary) which became adherent to the surrounding tissues(omentum and small bowel and massively adherent forming a complex adnexal mass.
In this case I would like to use 4920x –Excision, open, intra-abdominal Endometrioma (please get the size of the mass)
And adhesiolysis Code, 58740 (which is not a separate procedure)since it was a most involvingextensive adhesiolysis (it merits more than a Modifier22  or 59) .

So all together you would assign Cesar code, sterilization code, Endometrioma excision Code an adhesiolysis code. Some careers do not accept the adhesiolysis code . In that case, you would  have to append Modifier  59 to the Endomerioma excision code


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## nelamaria (Oct 21, 2010)

Thank you!, so much.


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