Ob-Gyn Coding Alert

Question: I need some assistance with choosing correct codes. I’m starting with 58760 for tubal fulguration. I’m stuck on the ovarian biopsy (58661 versus 58662) and cyst drainage.

From the op report:All 5 cysts were drained, but unable to enucleate d/t no thin membrane to pull from it inside the cyst walls. Therefore, a biopsy of the ovary with the cyst wall was taken with endoshears. Fallopian tubes were ligated with good results and destruction of tubes. Findings: Enlarged multicystic right ovary, clear fluid with in the cyst, normal fallopian tubes bilateral. 

What should I do?

Colorado Subscriber

Answer: You should report 49322(Laparoscopy, surgical; with aspiration of cavity or cyst [e.g., ovarian cyst] [single or multiple]), not 58661 (Laparoscopy, surgical; with removal of adnexal structures [partial or total oophorectomy and/or salpingectomy]) or 58662 (… with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method). The reason is he drained the cysts but did not remove the ovary and certainly did not describe an ovarian cystectomy in this note.

You can try to bill 49321 (…with biopsy [single or multiple]) for the biopsy, as it is not bundled into 49322.