Ob-Gyn Coding Alert

Find out how the weight of myomas can trump the number of them

Deciding which myomectomy code you-ll report depends on three factors: the approach the ob-gyn uses, the number of the myomas, and their weight. Here's how to translate this information into the correct CPT code every time.

Watch out: If your ob-gyn performs a hysterectomy, you won't report the myomectomy separately. Investigate Myomas and Their Types When your ob-gyn performs a myomectomy, he is removing myomas or uterine fibroid tumors. Knowing what type they are will help you to determine your myomectomy code.

What they are: Myomas (also known as uterine fibromas) are the most common growth of the female genital tract. They are round, firm, benign masses of the muscular wall of the uterus and are composed of smooth muscle and connective tissue.

You-ll see different types of uterine fibroids based on their location:

- Intracavitary myomas are fibroids inside the uterus.
- Submucous myomas are partially in the uterine cavity and partially in the wall of the uterus.
- Subserous myomas are on the outside wall of the uterus.
- Intramural myomas are in the wall of the uterus; their size can range from microscopic to larger than a grapefruit. These take a lot more effort to remove than a surface myoma.
- Pedunculated myomas are connected to the uterus by a stalk and are located inside the uterine cavity or on the outside surface. Did you know? Myomas often cause or are coincidental with abnormal uterine bleeding, pressure or pain. They are also one of the most common reasons women in their 30s or 40s have hysterectomies, says Peggy Stilley, CPC, ASC-OB, OGS, clinic manager for Women's Health Care Specialists in Tulsa, Okla.

However, women who want to have children in the future or simply do not want their uterus removed look for alternative solutions. The following procedures describe abdominal, vaginal, and laparoscopic approaches. 

Differentiate 2 Abdominal Myomectomy Codes First of all, look at the abdominal approach.

When the ob-gyn performs an abdominal myomectomy, he surgically removes the myoma from the uterus through an incision in the abdomen. For this procedure, you-ll report either 58140 (Myomectomy, excision of fibroid tumor[s] of uterus, 1 to 4 intramural myoma[s] with total weight of 250 grams or less and/or removal of surface myomas; abdominal approach) or 58146 (Myomectomy, excision of fibroid tumor[s] of uterus, 5 or more intramural myomas and/or intramural myomas with total weight greater than 250 grams; abdominal approach).

Catch this: These codes differentiate between the number of myomas (58140 for one to four; 58146 for five or more) and the total weight of intramural myomas (58140 for total weight of 250 grams or less; 58146 for total weight greater than 250 grams).

Example: If [...]