Ob-Gyn Coding Alert

Question: If a hysterectomy is performed in three parts with the adnexa being removed first and questionable tumor within the adnexa (example: right ovary with tumor, left ovary simple cyst and a hysterectomy with no abnormalities), what is the appropriate CPT code? What is the correct code for a dermoid cyst of the ovary, and if bilateral ovaries and hysterectomy are performed?

Ohio Subscriber

Answer: The procedure codes for hysterectomy state with or without tubes, with or without removal of ovaries (i.e., 58150, total abdominal hysterectomy [corpus and cervix], with or without removal of tube[s], with or without removal of ovary[s]). Therefore, many payers will not allow you to bill separately for the removal of a cyst or tumor from the ovary that you subsequently remove in its entirety. This same rule would apply if you removed a fibroid from within the uterus and then remove the uterus. The process, however, may add additional physician work to the procedure, and if this work has been documented along with the reason the tumor or cyst was removed, you may be able to claim additional reimbursement by appending -22 (unusual procedural services) to the hysterectomy code.

If, on the other hand, you left the tubes and ovaries, but instead removed only an adherent tumor or cyst, you might be able to bill for removal or aspiration by reporting the appropriate code and adding modifier -51 (multiple procedures) or -59 (distinct procedural service). The difference in modifiers is attributed to the CPT code nomenclature. For instance, 58900 (biopsy of ovary, unilateral or bilateral [separate procedure]) is a separate procedure that would take the -59 modifier if you have made a clinical case for the procedure. An ovarian cystectomy (58925, ovarian cystectomy, unilateral or bilateral), on the other hand, would not require modifier -59. Rather, the multiple-procedure modifier -51 would be added.

Note also that the codes for the biopsy and the cystectomy are unilateral/bilateral codes. It does not matter if the procedure is performed on one or both ovaries; the code reported is the same in either case. This answer applies equally to the second part of your question, when a dermoid cyst has been removed, but both ovaries also are removed. In this case, there is not a separate procedure to report.

The source for Reader Questions is Melanie Witt, RN, CPC, MA, former program manager for the American College of Obstetricians and Gynecologists department of coding and nomenclature and an independent coding educator.