General Surgery Coding Alert

Question: Our surgeon laparoscopically removed the patient’s right ovary and tube, but also lysed adhesions drained a left-paratubal cyst. Can we separately bill the paratubal-cyst aspiration, or is that included in the ovary-removal code?

Maryland Subscriber

Answer: Because the surgeon performed the procedures on two separate structures (left and right uterine adnexa), you can separately report the two procedures.

Use codes 58661 (Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy)) and 49322 (Laparoscopy, surgical; with aspiration of cavity or cyst (eg, ovarian cyst) (single or multiple)) for the two procedures.

Beware: Under the Correct Coding Initiative (CCI) edits, 49322 is a column 2 (component) code for more comprehensive procedure code, 58661. Because you’re billing both procedures on the same claim, you need to append modifier 59 (Distinct procedural services) to column 2 code 49322. This will let the payer know that the surgeon performed the procedures at different sites.

You’ll need to ensure that the op report documents drainage of paratubal cyst on the left side, and salpingo-oophorectomy on the right side. Some payers may require you to append modifier RT (Right side) to 58661 and LT (Left side) to 49322 to more clearly make your case.