Oncology & Hematology Coding Alert

Question: A 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 muscle 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 it’s recurrent ovarian cancer, would I code 58957?

The provider also removed several (about 10) “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 surgeon is doing is tumor debulking, which means removing as many visible tumors as possible wherever they are located.

CPT^® update alert: Be aware that, while 58957 is the accurate code to describe debulking in 2024, adjustments to reporting debulking services based on size will be coming to CPT® in 2025. Watch for updates to come!