Ob-Gyn Coding Alert

Question: My ob-gyn did a diagnostic laparoscopy, bilateral ovarian cystectomy, tubal chromotubation, and hysteroscopy dilation and curettage (D&C). How should I report this?
Iowa Subscriber

Answer: You should code a cystectomy without removing part of the ovary in the process as 58662 (Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method).
But if the ob-gyn removed part of the ovary in the process, you should report 58661 (Laparoscopy, surgical; with removal of adnexal structures [partial or total oophorectomy and/or salpingectomy]).
For some private-pay patients, be sure to add modifier 50 (Bilateral procedure) because CPT considers 58661 a unilateral procedure. But Medicare and other commercial payers disagree and do not accept modifier 50 with this code. Also, be sure to check the op note and path report for details because 58662 has a higher relative value unit (RVU).
You can also code the chromotubation (58350, Chromotubation of oviduct, including materials) if the ob-gyn diagnoses a problem. Again, not all payers will reimburse for it.
Code the hysteroscopic D&C with 58558 (Hysteroscopy, surgical; with sampling [biopsy] of endometrium and/or polypectomy, with or without D&C).