Ob-Gyn Coding Alert

Question: During an open procedure, the doctor performed a left salpingo-oophorectomy, pelvic and para-aortic lymph sampling, some other biopsies in the pelvic area, partial omentectomy, and a right ovarian biopsy. How should I report this?

Indiana Subscriber

Answer: Code 58943 (Oophorectomy, partial or total, unilateral or bilateral; for ovarian, tubal or primary malignancy, with para-aortic and pelvic lymph node biopsies, peritoneal washings, peritoneal biopsies, diaphragmatic assessments, with or without salpingectomy[s], with or without omentectomy) appears to match the procedures that the ob-gyn performed. But you can use this code only if the diagnosis from the pathology report comes back as ovarian, primary peritoneal or tubal cancer.
 
If the lesion is benign, you would code the individual procedures. You would report 58720 (Salpingo-oophorectomy, complete or partial, unilateral or bilateral [separate procedure]) for the left salpingo-oophorectomy. The National Correct Coding Initiative bundles 58900 (Biopsy of ovary, unilateral or bilateral [separate procedure]) into 58720 and does not allow you to bypass the edit with a modifier - meaning you cannot bill separately for the ovarian biopsy even though the surgeon took it from the ovary that he didn't remove. NCCI also bundles an omentectomy (49255, Omentectomy, epiploectomy, resection of omentum [separate procedure]) with 58720, so you couldn't report that separately.
 
For the pelvic and para-aortic lymph node sampling, you would use 38562-59 (Limited lymphadenectomy for staging [separate procedure]; pelvic and para-aortic; distinct procedural service). NCCI does not bundle this code with 58720, but CPT lists it as a "separate procedure." Consequently, you may want to add modifier -59 in case your payers use a different bundling system.

 - The answers for Reader Questions and You Be the Coder were provided by Melanie Witt, RN, CPC, MA, an ob-gyn coding expert based in Fredericksburg, Va.; and Harry L. Stuber, MD, an independent gynecologist based in Cookeville, Tenn.