Ob-Gyn Coding Alert

Question: Our ob-gyn did a laparoscopic left salpingectomy and a resection of left ovarian cyst. What is the CPT code for resection of ovarian cyst?

Kansas Subscriber

Answer: Because you have indicated that this was a laparoscopic procedure, your answer depends on whether your ob-gyn took part of the ovary along with the cyst. Your answer also depends on the reason for the removal; an ob-gyn can perform a salpingectomy for ectopic pregnancy or tubal infection (hydrosalpinx).

Ectopic pregnancy: If the ob-gyn performed the salpingectomy due to an ectopic pregnancy (633.10, Tubal pregnancy without intrauterine pregnancy), you should report 59151 (Laparoscopic treatment of ectopic pregnancy; with salpingectomy and/or oophorectomy) as the primary procedure.

Part of ovary removed: If the physician also removed part of the ovary along with the cyst, bill only 59151.

Tube and part of ovary removed: If the ob-gyn removes the tube for hydrosalpinx (614.1) and removes part of the ovary with the cyst, the code changes to 58661 (Laparoscopy, surgical; with removal of adnexal structures [partial or total oophorectomy and/or salpingectomy]).

Only the cyst removed: If the ob-gyn removes only the cyst in each case, you can try billing 58662 (Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method) along with 58661-51 (Multiple procedures) or 59151 with 58662-51 and see what happens.

Caution: Although the Correct Coding Initiative does not bundle these code combinations, some payers may balk at paying both codes. Before using this code combination, make sure you can link 58662 to an ICD-9 code for the ovarian cyst (once you know the pathology result) to show medical necessity. Appeal, if necessary.

-- The answers for Reader Questions and You Be the Coder were provided by Melanie Witt, RN, CPC-OGS, MA, an ob-gyn coding expert based in Guadalupita, N.M.