# Started as a diagnostic, ended with open surgery, but unsure of which codes to bill??



## Vanessa123 (Mar 6, 2010)

Hello everyone. 

I am looking for a little help on a surgery that started off with a diagnostic laparoscopy, turned into a exploratory laparotomy with the removal of a ovary and a tube.

Preoperative Diagnosis: Twisted right adnexa with ovarian cyst

Operative Procedure: Diagnostic laparoscopy, exploratory laparotomy, removal of right adnexa, twisted ovarian cyst and tube.

The dictation of the produce states that the physician started off with a diagnostic laparoscopy as she was in there she visualized a large mass in the cul-de-sac. It appeared to be the right adnexa with ovarian cyst and part of the tube. The size of the mass was more than 6.5 cm and it was decided to do the exploratory laparotomy. 

The uterus was made mobile using the Hulka, but during the procedure the Hulka spontaneously came out, and at this time mass was delivered with the left hand from the cul-de-sac and held with the Babcock forceps. It looked like the part of the tube and the ovary with the ovarian cyst appeared to be necrotic and completely congested. At this time, the area was examined and untwisted. Using the LigaSure, it was separated from the part of the tube which it was attached to. Hemostatsis was confirmed. The pedicle was doubly LigaSure and hemostatis was confirmed. At this time, the area was irrigated with plenty of saline, and the cul-de-sac was irrigated. The adnexa was looked at and was normal. 


We are wanting to code this as a 58720 but are wondering if we could bill for the 49000 or the 49320 from all the extra work the physician had to do to get to the point of removing tube and ovary. Or would we just code the 58720 with maybe a 22 modifier?

We recieved this from the physicians office with the codes to bill as 49320,49000-59, 58262. I think they were a little off.


Please help!

Thank you,

Vanessa


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## mitchellde (Mar 6, 2010)

Once you have performed a definitive procedure you may not code the diagnostic I say go for the 58720 with the 22 modifier.


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## Lisa Bledsoe (Mar 8, 2010)

Also, as an additional dx (not primary) use V64.41.


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## amy_mousie (Jul 14, 2010)

*Exploratory laparoscopy, exploratory laparotomy with colon resection and colostomy*

I'm new to this speciality
per above, since the exploratory laparoscopy was performed and identified a hole within the colon at the distal sigmoid proximal rectum the physician convert to a lapartomy to preform a resection at the perforation  end and mobilize the colostomy .  

Would you only use codes 44141, 44320-59


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## Lisa Bledsoe (Jul 14, 2010)

44320 is inclusive to 44141 and cannot be reported even with modifier -59 per CCI edits.


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