Wiki Help needed with CPT code

[ErinW]

Hello

My general surgeon was called in to assist an OB/GYN during surgery for a large ovarian cyst. I am having trouble determining the correct CPT code for his part of the surgery. The OB/GYN had started the surgery and encountered a large ovarian mass/cyst with small bowel densely adherent to it and to the anterior abdominal wall. My doc was called in and he dissected the cyst from the abdominal wall as well as from omentum. There was also small bowel stuck to the cyst and during dissection an incidental enterotomy occurred. He attempted lap repair but ended up doing a mini laparotomy to repair the enterotomy.

I think the code should be 58660 but my doc thinks I should bill for the enterotomy repair. I don't think I should bill for an issue caused by him during the surgery.

Any thoughts would be appreciated.

Erin

 

[cpc2007]

Hi Erin,

I agree with your assessment that the enterotomy repair should not be reported. A guideline you may be able to share with your surgeon to explain why you wouldn't report this code is in the NCCI policy manual which is published by CMS. This guideline is in chapter 6 which covers the 40000 codes and in section E (abdominal procedures), and point #10:

If an iatrogenic laceration/perforation of the small or large intestine occurs during the course of another procedure, repair of the laceration/perforation is not separately reportable. Treatment of an iatrogenic complication of surgery such as an intestinal laceration/perforation is not a separately reportable service. For example CPT codes describing suture of the small intestine (CPT codes 44602, 44603) or suture of large intestine (CPT codes 44604, 44605) shall not be reported for repair of an intestinal laceration/perforation during an enterectomy, colectomy, gastrectromy, pancreatectomy, hysterectomy, or oophorectomy procedure.

Because the injury to the intestine occurred during the performance of another procedure, this guideline prevents you from reporting the repair. If your surgeon and the OBGYN ended up removing the ovary in part or in total to achieve resection of this mass, I would agree with 58661 and would recommend modifier 62 for the two of them to bill as co-surgeons (OBGYN opened and presumably removed the ovary in the end, but your surgeon from general surgery freed the ovary from surrounding structures in the abdomen so they are both doing a part of a procedure reported with the same CPT code).

I hope that helps

Have a great day
Kim
www.codingmastery.com