Ob-Gyn Coding Alert

Question: My ob-gyn performed a laparoscopy and irrigated a right ovarian cyst. Should I report 58662? How about if he performs a laparoscopy with the resection of bilateral endometriomas?

Texas Subscriber

Answer: You need to refer to your physician's notes. Did he aspirate or drain the right ovarian cyst? If so, you should report 49322 (Laparoscopy, surgical; with aspiration of cavity or cyst [e.g., ovarian cyst] [single or multiple]).

As for the resection of bilateral endometriomas, you would choose your code depending on whether the physician removed any part of the ovary with them. If so, you should report 58661 (... with removal of adnexal structures [partial or total oophorectomy and/or salpingectomy]). If not, then you should report 58662 (... with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method).

However, you may not bill for both the aspiration of the cyst and its removal. In that case, you would bill only the most extensive procedure, which would be the removal of the cyst.

Heads up: Per a CPT® Assistant clarification, the code 58661 does not take a modifier 50 for a bilateral procedure; however, per the Medicare database, they now allow a modifier 50 on this code. Be sure you know which rule your payer is following if the code 58661 is the one you are billing.