ICD 10 Coding Alert
Use Location for Dx, Recurrent for Procedure, in This Pelvic Mass Scenario
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? Mississippi 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: 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.
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