Ob-Gyn Coding Alert

Question: How should I code for a diagnostic laparoscopy with irrigation of serosanguineous fluid in the cul de sac? The diagnosis is ruptured follicle of right ovary and polycystic ovary syndrome.


South Carolina Subscriber  
Answer: Although you may be tempted to submit 49322 (Laparoscopy, surgical; with aspiration of cavity or cyst [e.g., ovarian cyst] [single or multiple]) because of the diagnosis, report this procedure as 49320 (Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]).
 
You should not use 49322 because, when performing the diagnostic laparoscopy, the ob-gyn may push organs around with probes or graspers, irrigate with saline, and suction the irrigation or whatever he or she might find in the cul de sac. The physician performs these tasks to more clearly visualize the patients anatomy. Even if the doctor lyses adhesions that get in the way, it is included as part of the diagnostic laparoscopy and is not separately billable.   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.