Ob-Gyn Coding Alert
Debulking Means Removing Tumors
Question: Patient with recurrent ovarian cancer with previous TAH/BSO undergoes new surgery for excision of 6.7 x 4.8 x 3.3 cm pelvic mass attached not only to the lesser pelvic sidewall but also to the rectosigmoid. Serosa of the rectosigmoid was removed along with the mass to get a negative margin and the muscles of the rectosigmoid appeared not to be involved and were preserved. Rectosigmoid defect was repaired. I am thinking of reporting 49204 for removal of the mass. Or because its recurrent ovarian cancer, would I code 58957? They also removed several (about 10), what the doctor called “nodules” from the liver, rectum, and sigmoid that were anywhere from 3.4 cm to 1.9 cm in size. How would those be coded? California Subscriber Answer: Code 58957 (Resection [tumor debulking] of recurrent ovarian, tubal, primary peritoneal, uterine malignancy [intra-abdominal, retroperitoneal tumors], with omentectomy, if performed) would be best. What the physician is doing is tumor debulking, which means removing as many visible tumors as possible wherever they are located. 
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