The provider dropped 58660 - Laparoscopy surgical: with lysis of adhesions and 58925 - Ovarian cystectomy
I'm coming up with CPT code 49322 Laparoscopy, Surgical; with aspiration of cavity or cyst - Per the report below the this done Laparoscopy and the cyst was drained not removed. I disagree with coding 58660 as this would be included in the primary code of 49322. I also feel that modifier 22 would not apply as there was no documentation support the use of this modifier.
I'm I correct with only coding the 49322. I look forward to responses.
Pre-OP Diagnosis - Pelvic and perineal Pain R10.2 and Complex ovarian cyst N83.201
Procedures: DIAGNOSTIC LAPAROSCOPIC CYSTECTOMY , LYSIS OF ADHESIONS
Indications: . female who is having surgery for Pelvic and perineal pain [R10.2] and 6 cm ovarian cyst.
Attention was then turned to the patient's abdomen. The infraumbilical skin fold was anesthetized with 2 mL of 0.25 percent Marcaine. An infraumbilical vertical, 5 mm skin incision was made with the scalpel. A Veress needle was used to enter the abdomen, correct placement confirmed with saline drop test and opening pressure of 6mmHg. Once Intra-abdominal insufflation was noted to be adequate, the Veress was removed. A direct technique using an visible trocar with the 5mm laparoscope, was performed to successfully to enter into the abdomen. A survey of the abdominal contents noted to be normal, stable, without injury. Uterus with large adhesion from fundus to anterior abdominal wall noted. Multiple adhesions of omentum at level of trocar to anterior abdominal wall. The left ovary was surgically absent. The right fallopian tube appeared normal. The right ovary was approx. 4cm and cystic appearing. It was adhered to the right pelvic sidewall. The patient was placed in Trendelenburg. At this time, the RLQ region was transilluminated, and an accessory trocar site was mapped out. The skin was first anesthetized with 2 mL of 0.25 percent Marcaine. Under direct visualization with the laparoscope, a 5 mm skin incision was made with the scalpel, and the 5 mm trocar was placed under direct visualization with the laparoscope successfully. Same procedure was performed for a LLQ port entry, and a 5 mm trocar was placed.
The Voyant was used to take down the large adhesive band from the anterior abdominal wall. This freed up the uterus. Then the omental adhesions were taken down with the Voyant device. At this time, attention was back to the right ovary. The harmonic device was used to make an incision and the cyst was drained. An exploration of the ovarian cyst revealed no cyst wall that could be removed. Perclot was placed inside the open cyst wall and good hemostasis was noted.
I'm coming up with CPT code 49322 Laparoscopy, Surgical; with aspiration of cavity or cyst - Per the report below the this done Laparoscopy and the cyst was drained not removed. I disagree with coding 58660 as this would be included in the primary code of 49322. I also feel that modifier 22 would not apply as there was no documentation support the use of this modifier.
I'm I correct with only coding the 49322. I look forward to responses.
Pre-OP Diagnosis - Pelvic and perineal Pain R10.2 and Complex ovarian cyst N83.201
Procedures: DIAGNOSTIC LAPAROSCOPIC CYSTECTOMY , LYSIS OF ADHESIONS
Indications: . female who is having surgery for Pelvic and perineal pain [R10.2] and 6 cm ovarian cyst.
Attention was then turned to the patient's abdomen. The infraumbilical skin fold was anesthetized with 2 mL of 0.25 percent Marcaine. An infraumbilical vertical, 5 mm skin incision was made with the scalpel. A Veress needle was used to enter the abdomen, correct placement confirmed with saline drop test and opening pressure of 6mmHg. Once Intra-abdominal insufflation was noted to be adequate, the Veress was removed. A direct technique using an visible trocar with the 5mm laparoscope, was performed to successfully to enter into the abdomen. A survey of the abdominal contents noted to be normal, stable, without injury. Uterus with large adhesion from fundus to anterior abdominal wall noted. Multiple adhesions of omentum at level of trocar to anterior abdominal wall. The left ovary was surgically absent. The right fallopian tube appeared normal. The right ovary was approx. 4cm and cystic appearing. It was adhered to the right pelvic sidewall. The patient was placed in Trendelenburg. At this time, the RLQ region was transilluminated, and an accessory trocar site was mapped out. The skin was first anesthetized with 2 mL of 0.25 percent Marcaine. Under direct visualization with the laparoscope, a 5 mm skin incision was made with the scalpel, and the 5 mm trocar was placed under direct visualization with the laparoscope successfully. Same procedure was performed for a LLQ port entry, and a 5 mm trocar was placed.
The Voyant was used to take down the large adhesive band from the anterior abdominal wall. This freed up the uterus. Then the omental adhesions were taken down with the Voyant device. At this time, attention was back to the right ovary. The harmonic device was used to make an incision and the cyst was drained. An exploration of the ovarian cyst revealed no cyst wall that could be removed. Perclot was placed inside the open cyst wall and good hemostasis was noted.
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