Although a limited number of codes exist to diagnose and bill for endometrial cancer surgeries, a careful reading of the operative reports and an itemization of what was done in the operating room can lead to optimal reimbursement. Knowing what items are bundled, and when they can be unbundled is another step toward billing for everything that is allowable in these advanced surgeries.
Treatment for endometrial cancer is usually a combination of radiation and surgery. Because of the limited number of CPT codes for endometrial surgeries, and the single ICD-9 code for cancers limited to the endometrium, coders often code for long, complicated surgeries with little supporting materials. A patient may have endometrial cancer (182.0, malignant neoplasm of body of uterus; corpus uteri, except isthmus [includes the cornu, fundus, endometrium and myometrium] or 182.1, malignant neoplasm of body of uterus; isthmus [lower segment of the uterus]) and have surgery to remove it.
The techniques for removing this cancer are very similar to those used to remove ovarian, tubal or primary peritoneal cancer. Yet the procedure codes for that type of cancer cannot be used without a diagnosis of ovarian, tubal or primary peritoneal cancer, and procedure codes specific to complicated endometrial cancer surgery are hard to come by. With non-ovarian/tubal cancers, coders need to find the CPT codes that are the closest approximation to what was done in the operating room, making sure that all of the procedures are linked to a justifying diagnosis. Melanie Witt, RN, CPC, MA, an
ob/gyn coding expert and independent coding educator, offers a breakdown of the most common endometrial cancer surgeries and reveals some pitfalls of and solutions for comprehensive coding.
Coding Case Studies
The treatment chosen for endometrial or uterine cancer depends largely on how advanced the cancer is. Other factors include age of the patient, overall health and whether the patient wishes to have children. And while a combination of treatments surgery, radiation therapy, hormonal therapy and chemotherapy may be pursued, the ob/gyn surgeon or ob/gyn oncologist will primarily be involved in the surgical aspects of the patients care. Depending on the extent of the cancer, the following surgeries may be performed:
Hysterectomy: The basic procedure will be the removal of the uterus, tubes and ovaries. Most often this is accomplished abdominally and coded 58150 (total abdominal hysterectomy [corpus and cervix], with or
without removal of tubes[s], with or without removal of ovary[s]). The basic hysterectomy is performed when cancer has not spread outside the uterus and the cancer has not deeply invaded the uterine lining (stage-one cancer). This surgical approach is usually preferred because of better access to the peritoneal cavity for assessment, removal of the ovaries [...]
