Ob-Gyn Coding Alert

Question: I need help with an op note:

“Name of procedure: Diagnostic laparoscopy, right ovarian cystectomy, lysis of adhesions, drainage of left tubo-ovarian abscess.

“Diagnosis: Adnexal mass, right ovarian vein clot, high suspicion for pelvic inflammatory disease and tubo-ovarian abscesses.”

The notes state: “On inspection, I noted purulent adhesions. Left tubo-ovarian abscess adhered to the let pelvic sidewall. This abscess was approximately 5 x 5 cm. There was also an abscess on the right ovary measuring 4 x 5 cm with adhesions.”

The CPT^® manual indicates to use 58661 for ovarian cystectomy, but the description states, “with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy.” The doctor did not remove any of the ovaries or tubes, just the mass that was on the ovaries. How should I code this?

Florida Subscriber

Answer: Without having the entire op report, it’s difficult to code for the entire surgery. But the difference between a laparoscopic cystectomy and removal of part or all of an ovary is an important one from a coding and payment perspective. However, the current CPT^® manual (2018) does not indicate you should report 58661 for an ovarian cystectomy. If you check the index under “cystectomy, ovarian, laparoscopic,” you will see that the code 58662 (Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method) is listed.

Code 58661 (Laparoscopy, surgical; with removal of adnexal structures [partial or total oophorectomy and/or salpingectomy]) has fewer relative value units (RVUs) than 58662— 58661 has 11.35 physician work RVUs, while 58662 has 12.15 RVUs.

You’ll report 58661 when your ob-gyn takes part of the ovary along with the cyst, and 58662 when the ob-gyn only takes the cyst.

This surgeon also apparently drained an abscess on the left side. You can report this procedure as 49322 (Laparoscopy, surgical; with aspiration of cavity or cyst [e.g., ovarian cyst] [single or multiple]). Link this to tubo-ovarian abscess ICD-10 code N70.93 (Salpingitis and oophoritis, unspecified).

You may not report lysis of adhesions separately with these codes. If the physician has documented an extensive amount of work involved, you might be able to ask for additional reimbursement by adding modifier 22 (Increased procedural services) to 58662. Wait for the path report before assigning a code for the ovarian cyst type.