Case Study:
Coding Correctly for Ovarian Cystectomies
Published on Thu Jul 01, 1999
Case Description
A 30-year-old female, para 0, with a preoperative diagnosis of right ovarian dermoid cyst, is admitted for a laparoscopic ovarian cystectomy. Previously, after complaining of generalized pelvic pain, the patient had undergone a CT scan that showed a right ovarian cyst, possibly a dermoid cyst. Smaller cysts also were found on the left ovary.
Operative Report
The laparoscopic view of the pelvis demonstrated bilateral ovarian cysts. The largest, about 4-5 cm in diameter, was on the right side. A luteal cyst was also present in the right ovary. On the left ovary, a corpus luteum or follicular cyst was present in addition to another dermoid cyst.
Through three ports, various instruments were used to remove the ovarian cysts, as follows: Attention was directed to the right ovary. The capsule of the ovary was incised with a Corson needle passed through the suction irrigation tip. The capsule was then grasped with grasping forceps and peeled back, exposing the cyst, which was peeled out of the ovary. This was carried out on the right side without much difficulty, and after removal from the ovary, the cyst was placed in a plastic catch bag and brought out through the left lower quadrant port. The ovary was then inspected for bleeding and some small venous bleeding was cauterized with the Corson needle.
Attention was then directed to the left ovary and the cyst that appeared to be follicular was ruptured with the Corson needle and clear fluid drained. The other cyst was approximately 2-3 cm in diameter. It was opened with a Corson needle and found to be a dermoid cyst. The suction tip device was introduced in the cyst cavity and it was ultimately emptied and irrigated until clear fluid was obtained. The ovary was then opened further and the cyst contents and the cyst were peeled out of the ovary. Where the cyst wall appeared to still be adhered, it was cauterized with the Corson needle.
The operative summary lists the postoperative diagnoses as bilateral ovarian dermoid cysts and pelvic endometriosis.
Coding Dilemma
CPT guidelines say that when a procedure is performed through a scope, it should not be coded using an open code. This is because the surgical technique is different, requiring a different level of physician work and much less postoperative care. The AMA coding staff instead indicates that a laparoscopic code should be used to report the service even when a CPT code exists that describes the open procedure.
Yet the laparoscopic code range (56300-56344) does not contain a [...]
