General Surgery Coding Alert

Question: Our surgeon performed an open procedure to "debulk" a tumor by excising a 6.7 x 4.8 x 3.3 cm pelvic mass attached not only to the lesser pelvic sidewall but also to the fallopian tube of a patient with recurrent ovarian cancer. What are the correct ICD-10 and CPT^® codes for this case?

Arkansas Subscriber

Answer: Despite association of the mass with the fallopian tube, or the surgeon describing the specimen as a "pelvic mass," you should code the mass based on the diagnosis.

That means the correct code is one of the following, depending on the cancer location:

• C56.1 (Malignant neoplasm of right ovary)
• C56.2 (... left ovary)
• C56.9 (... unspecified ovary).

Because this is a recurrent cancer at the initial site, you should not use a code for metastatic cancer from a distant site.

The most appropriate code for the procedure is 58957 (Resection [tumor debulking] of recurrent ovarian, tubal, primary peritoneal, uterine malignancy [intra-abdominal, retroperitoneal tumors], with omentectomy, if performed). This is a better choice than a code such as 49204 (Excision or destruction, open, intra-abdominal tumors, cysts or endometriomas, 1 or more peritoneal, mesenteric, or retroperitoneal primary or secondary tumors; largest tumor 5.1-10.0 cm diameter), again, because it is consistent with the diagnosis of recurrent ovarian cancer.