Wiki Exploratory laparotomy with cytoreductive surgery- Help please

[kathleeng]

I'm am still learning surgeries and this is the first that I've had to review one for cytoreductive surgery. We are not doing the HIPEC portion. Everything that I research states there is not specific CPT for the cytoreductive surgery but can be series of codes due to the various components being removed. Our doctor performed the procedure due to ovarian cancer and rectal tumor consistent with recurrent ovarian cancer. We performed an exploratory laparotomy and specimens removed were: pelvic adhesions, RT pelvic sidewall mass, RT perimetrium, LT perimetrium, LT paravaginal nodule, LT deep pelvic sidewall nodule, upper vagina, and the rectum anus sigmoid. At first I was looking at 49203 but then I was led to 58960 due to the ovarian cancer, but I feel like there are definitely other codes that I should be looking at. Any feedback would be greatly appreciated!

 

[csperoni]

There are several options for ovarian cancer debulking surgeries.
58960 does not seem correct since it does not appear lymph nodes were removed. 49203 seems selling yourself short, especially since this really was a debulking. Perhaps
-58957 Resection (tumor debulking) of recurrent ovarian, tubal, primary peritoneal, uterine malignancy (intra-abdominal, retroperitoneal tumors), with omentectomy, if performed
58957 would cover pelvic adhesions, RT pelvic sidewall mass, RT perimetrium, LT perimetrium, LT paravaginal nodule, LT deep pelvic sidewall nodule
-57106 Vaginectomy, partial removal of vaginal wall
57106 would cover upper vagina
For "rectum anus sigmoid" well beyond my standard scope of expertise since I work for gynonc. There must have been some type of colostomy performed. You would need to reference the op note, not just the specimens removed to determine how to code that. 44xxx-46xxx

 

[kathleeng]

There are several options for ovarian cancer debulking surgeries.
58960 does not seem correct since it does not appear lymph nodes were removed. 49203 seems selling yourself short, especially since this really was a debulking. Perhaps
-58957 Resection (tumor debulking) of recurrent ovarian, tubal, primary peritoneal, uterine malignancy (intra-abdominal, retroperitoneal tumors), with omentectomy, if performed
58957 would cover pelvic adhesions, RT pelvic sidewall mass, RT perimetrium, LT perimetrium, LT paravaginal nodule, LT deep pelvic sidewall nodule
-57106 Vaginectomy, partial removal of vaginal wall
57106 would cover upper vagina
For "rectum anus sigmoid" well beyond my standard scope of expertise since I work for gynonc. There must have been some type of colostomy performed. You would need to reference the op note, not just the specimens removed to determine how to code that. 44xxx-46xxx

Wow you're awesome! Yes, you are correct. There was a colostomy performed, however another doctor did that portion and realized that the other doctor performed the removal of the rectum anus sigmoid portion at that time. I appreciate your feedback so much!