Question: An ob-gyn performed a diagnostic laparoscopy, bilateral ovarian cystectomy, tubal chromotubation, and hysteroscopy dilation and curettage (D&C) in the ASC. How should I report this?
Iowa Subscriber
Answer: You should code a cystectomy without removing part of the ovary in the process as 58662 (Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method]: APC 0131).
But, if the ob-gyn removed part of the ovary in the process, you should report 58661 (Laparoscopy, surgical; with removal of adnexal structures [partial or total oophorectomy and/or salpingectomy]: APC 0131).
Medicare and many commercial payers do not accept modifier 50 (Bilateral procedure) with 58661 (indeed, Medicare advises against using modifier 50 in the ASC at all times), although CPT lists the code as unilateral.
You can also code the chromotubation (58350, Chromotubation of oviduct, including materials: APC 0195) if the ob-gyn diagnoses a problem. Again, not all payers will reimburse for it.
You may report the hysteroscopic D&C with 58558 (Hysteroscopy, surgical; with sampling [biopsy] of endometrium and/or polypectomy, with or without D&C: APC 0190).
