Ob-Gyn Coding Alert

Question: Our ob-gyn did a laparoscopy with aspiration of one ovarian cyst and then drilled both ovaries in multiple locations with the needle-tip bovie, noting that there were numerous small cysts and lots of clear fluid, which would come out each time. Is this a 49322, or is there another code I should use?

Arizona Subscriber

Answer: The American College of Obstetricians and Gynecologists (ACOG) recently clarified how to report this procedure. You should use 58662 (Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method) because the procedure destroys parts of the ovary.
 
Although the Correct Coding Initiative (CCI) does not bundle the laparoscopic ovarian cyst aspiration code (49322, Laparoscopy, surgical; with aspiration of cavity or cyst [e.g., ovarian cyst] [single or multiple]) with 58662, you may still find this code combination denied as incidental to the primary, more extensive procedure. In other words, because the one cyst aspiration is very like the ovarian drilling, you should only report the drilling (58662). Your payers may include the lesser-valued code (49322) anyway through their own specific bundle or ClaimCheck.