Thank you so much for your help, Csperoni. I love learning and strive to become an excellent coder= it’s fun. So, what I understood from this report that both ovaries are multicystic. MD excised cysts on Right at posterior cut-de-sac and another cyst on Left at superior to uterus =59662-50. Is that right?
1) I think you mean 58662-50, not 59662-50. However, 58662-50 is not correct for 2 reasons. First, -50 is not a valid modifier for that code. Second, I do not see where in this op note the physician performed an ovarian cystectomy. The op note is slightly vague, but appears to indicate the cyst was aspirated, then wall was removed while the ovary was resected. 49322 is a column 2 code with 58661 and -59/-XU does not seem appropriate to me. Under specimens removed, it does not state cysts. Sometimes looking at the pathology report can help. If pathology report indicated separate specimens of cyst (not just fluid) and portions of ovaries, I would query the physician further. The size and location provided appears to be of the ovaries, not of the cysts. ie "left [ovary] was 8cm and superior to the uterus and the right [ovary] was 10+cm and in the posterior cul-de-sac.
Next, MD did partial resection of both ovaries = 59661-50. Is that right?
2) I think you mean 58661-50, not 59661-50, in which case I agree.
What I don’t understand which parts he removed: the ones with cyst or separately identifiable parts of ovaries(different from the areas 59662), in addition to 59662?
If MD removed the parts that contained those cysts, then we code only 59661, correct?
Procedure performed: Bilateral laparoscopic cystectomy and partial oophorectomy
Indications: recurrent symptomatic enlarged cystic ovaries. Cytology had previously been sent on vaginally aspirated cyst fluid and confirmed benign nature as did prior pathology from laparoscopy x 2 with ovarian cystectomy.
Findings:
On laparoscopy, ovaries were bilaterally multicystic and enlarged--the left was 8cm and superior to the uterus and the right was 10+cm and in the posterior cul-de-sac.
Procedure: …..
At the umbilicus, the skin was infiltrated with marcaine. A 5 mm vertical incision was made I….. followed by the 5 mm 0 degree laparoscope. ….. A5 mm port and a 10mm port were placed in the right and left lower quadrants respectively, both under direct visualization.
Attention was turned to the left ovary. A laparoscopic needle on a syringe was used to aspirate the majority of the cyst fluid from the largest cysts, a sample of which was sent for cytology. Roughly half of the ovary was then resected with the ligasure cautery. The cyst wall from the largest cyst was also removed. The sample was removed from the body using a 11mm endocatch bag and sent to pathology. Attention was then turned to the right ovary where a similar process was repeated. The sample again was removed from the body in a 11mm endocatch bag and sent to pathology.
The ovaries were returned to their anatomic positions and the abdominal cavity was irrigated with warm fluid. ….. The Foley catheter was removed…
Specimens: cyst fluid from left and right ovarian cyst; portion of left and right ovary