Ob-Gyn Coding Alert

From the Ob-Gyn Coding Alert
Extra Supplement on Endoscopic Procedures

Question: How should I code laparoscopy with right ovarian cystectomy and fulguration of endometrial implants? Should I use 58662 and 58660-59 or just 58662?

New Jersey Subscriber

Answer: You should use 58662 (Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method) to report the fulguration of endometrial implants and the ovarian cystectomy because this code describes both of these procedures. In this case, if the physician has documented significant additional work when doing both, modifier -22 (Unusual procedural services) can be added to 58662. You should include documentation with the claim explaining the additional work, however. But note that if part of the ovary was removed with the cyst, you could report 58661-51 (Laparoscopy, surgical; with removal of adnexal structures [partial or total oophorectomy and/or salpingectomy]; multiple procedures) in addition to 58662.

Code 58660, on the other hand, is used to report laparoscopic lysis of adhesions, a procedure this physician apparently did not perform. If the documentation had described lysis of adhesions and the procedure had been documented as distinct from the ovarian cystectomy, you could have reported 58660 in addition to 58662. You would need to append both modifier -59 (Distinct procedural service) and -51 to this code.