Ob-Gyn Coding Alert

Question: My ob-gyn did a laparoscopic radical parametrectomy with an upper vaginectomy. What CPT code should I report?

Wyoming Subscriber

Answer: Under CPT® rules, if the ob-gyn does a procedure laparoscopically, you must use an appropriate laparoscopic code -- even if he does a procedure via another approach that matches this service.  

In this case, the code that best approximates what the ob-gyn did would be 57107 (Vaginectomy, partial removal of vaginal wall; with removal of paravaginal tissue [radical vaginectomy]). However, the ob-gyn did employ a laparoscopic approach, and so you cannot report the vaginal approach procedure.  

Therefore, you should go with 49329 (Unlisted laparoscopy procedure, abdomen, peritoneum and omentum), because the uterus is no longer there and he is now working within the peritoneal cavity. You can compare the work to 57107 (with 41.87 RVUs).  

If he had also removed the pelvic lymph nodes, the work would have been closer to a radical hysterectomy (58548, Laparoscopy, surgical, with radical hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling [biopsy], with removal of tube[s] and ovary[s], if performed, with 53 RVUs) even though the uterus was no longer present. But since you have no documentation of this, you should go with the 57107 for the comparison code with the payer.