Ob-Gyn Coding Alert

Question: Patient is one day post-op for 58548 (Laparoscopy, surgical, with radical hysterectomy, with bilateral total pelvic lymphad­enectomy and para-aortic lymph node sampling (biopsy), with removal of tube(s) and ovary(s), if performed). Then the ob-gyn went back in for an intraperitoneal hematoma. They performed a laparoscopic evacuation of hematoma and exploration for bleeding vessels, with coagulation and vascular clips applied. I am billing 49322 for the hematoma and 49329 for cautery and clips. Are there more applicable CPT^® codes for this?

Texas Subscriber

Answer: You should only be billing 49322 (Laparoscopy, surgical; with aspiration of cavity or cyst (eg, ovarian cyst) (single or multiple)). You should not report a code for the hemostasis, because it is now part of the procedure. And don’t forget the modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period).