# Preop dx appy, postop dx hemorrhagic ovarian cyst



## trinalankford (Apr 13, 2011)

My doc (general surgeon) went into this case, expecting to find a hot appendix, and ended up with a ruptured ovarian cyst. We do absolutely no OB/GYN in this office, so this CPT coding is not familiar to me.

The abdomen was entered through a transverse incision over McBurney point. Dissection was carried down to the fascia which was incised in the direction of its fibers. The muscles were then separated by blunt dissection to expose the peritoneum. Upon opening the peritoneum, there was dark blood and some fresh blood. Incision was extended to involve both the anterior and posterior rectus sheath medially. Appropriate retractors were placed....Appendix was not acutely inflamed or edematous...Attention was turned to exploration of the ovary. It did have an adherent clot which was removed. Bleeding was brisk from the surface of the cyst. The bleeding was controlled by running mattress suture on the bleeding edge of the ruptured cyst. This adequately controlled the bleeding. Attention was turned to closing the wound...

I am having trouble locating the correct code for the suture control of the ovary/cyst.

Thank you!


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## FTessaBartels (Apr 19, 2011)

*58925*

I am *NOT* an expert in OB-GYN ... But have you looked at 58925?

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## trinalankford (Apr 21, 2011)

I did see that one, literally went through the OB/GYN section code-by-code, but didn't think that was the correct code, looking instead for a suture control of the ovary.

I know I'm probably making this particular report much more difficult than it should be 

Thanks.


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## preserene (Apr 23, 2011)

Well it was done by a Surgeon and not by an OBGYN. The surgery intended was on appendix.
 Well, any way he said rightly it is a haemorrhagic Ovarian Cyst.
Hemmorragic ovarain Cyst is otheriwse known as *chocholate cyst of the ovary*. in otherwords , *Ovarian Endometriosis*.
 If he just opened the cyst and drained ( cystotomy, be it accidental or intentional all the same for coding)) , then you can give *58800.*
If he did a cystectomy ( cyst removed), then it is very much apt to give* 58925.*
 please support with the an appropriate diagnosis. ( chocholate cyst of the ovary). Still doubtful, confirm with the surgeon for the diagnosis.- was it a hemorragic ovarian Cyst/Chocholate cyst of the ovary/ endometriosis of the ovary.
Thank you.


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## trinalankford (Apr 26, 2011)

preserene said:


> If he just opened the cyst and drained ( cystotomy, be it accidental or intentional all the same for coding)) , then you can give *58800.*
> If he did a cystectomy ( cyst removed), then it is very much apt to give* 58925.*
> please support with the an appropriate diagnosis. ( chocholate cyst of the ovary). Still doubtful, confirm with the surgeon for the diagnosis.- was it a hemorragic ovarian Cyst/Chocholate cyst of the ovary/ endometriosis of the ovary.
> Thank you.



He did NOT open the cyst and drain it...the cyst was already open (ruptured) upon him discovering it...so 58800 not appropriate.

He did NOT remove the cyst so no cystectomy performed...so 58925 not appropriate.

He simply SUTURED the cyst closed.

I have confirmed the diagnosis with the surgeon, and he wants me to bill out open appy and forget the ovarian cyst...although it is very clear that without the ovarian cyst, this procedure would NOT have taken place.

Ugh.


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## MJ4ever (Apr 26, 2011)

This may be totally off the ball park, but how about:
49322 Laparoscopy, with aspiration of cavity (or cyst). I understand the cyst was not aspirated. Did the surgeon possibly asire the cavity?
Just an idea.


Good Luck


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