Ob-Gyn Coding Alert

Question: The ob-gyn did a hysteroscopy, endomyometrial biopsy and dilation of cervix with curettage (58558). Then he did a laparoscopy with laparoscopic peritoneal biopsies of the left anterior peritoneum and the right posterior peritoneum, which I coded as 49321. He also did a right ovarian biopsy and right ovarian paratubal cystectomy with an add-on appendectomy. What should I code for the right ovarian biopsy with right ovarian paratubal cystectomy?

Florida Subscriber

Answer: First of all, a biopsy is a biopsy is a biopsy. You should report 49321 (Laparoscopy, surgical; with biopsy [single or multiple]) for all of them.

For the paratubal cystectomy, you should report 58662 (Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method). 

If you don't have medical indication for the appendectomy, your carrier will not reimburse for it. While the code you could report (44970, Laparoscopy, surgical, appendectomy) does not specify the reason for removing it, medical necessity must support any appendectomy your ob-gyn performs. If the ob-gyn lists the appendectomy as incidental and the appendix turns out to be healthy, you are unlikely to receive reimbursement.