General Surgery Coding Alert

Question: The surgeon excised a 6.6 x 4.6 x 3.4 cm pelvic mass attached to the lesser pelvic sidewall and the rectosigmoid. The clear margins included rectosigmoid serosa, and the surgeon repaired the rectosigmoid defect. The surgeon also removed three “nodules” from the liver, rectum, and sigmoid that were 3.3, 1.9, and 2.3 cm in size, respectively. The patient had recurrent ovarian cancer. Should I code the procedure as 49204?

California Subscriber

Answer: No, code 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) would not be the best choice for this scenario.

Here’s why: Because the patient has recurrent ovarian cancer, what the surgeon is doing in this case is “debulking” the tumor, which means removing as many visible tumors as possible, wherever they are located in the intra-abdominal and retroperitoneal space.

A better code choice for this scenario is 58957 (Resection (tumor debulking) of recurrent ovarian, tubal, primary peritoneal, uterine malignancy (intra-abdominal, retroperitoneal tumors), with omentectomy, if performed).

Although code 49204 may represent removal of cancer that has spread to the intra-abdominal space from another location, you should always choose the most specific code available, which is 58957 in this case.