Ob-Gyn Coding Alert

Question: If the doctor had made multiple punctures, and this was an ovarian drilling procedure (or the doctor had called it an ovarian drilling), would the code be 49322? I did read in archives that ACOG in 2013 recommended 58661, but there could be an issue between CPT^® and Dx coding for PCOS. Not medically indicated. I also read that 58679 (Unlisted laparoscopic, oviduct, ovary) was the best code to use. I have a terrible time getting any unlisted CPT^® codes paid. Despite sending records and letter explaining my reason, cost, compare this to, etc. I would prefer 49322. Is this acceptable?

South Carolina Subscriber

Answer: You should not use 58661 (Laparoscopy, surgical; with removal of adnexal structures [partial or total oophorectomy and/or salpingectomy]) since the ob-gyn is not excising parts of the ovary; just putting holes in it.

Women with PCOS usually have ovaries with a thick outer layer which allows the ovaries to make more testosterone. High levels of this hormone can lead to irregular periods, acne, extra body hair, and of course issues with fertility. Ovarian drilling works by breaking through the thick outer layer of the ovary, which in turn lowers the amount of testosterone made by the ovaries. Physicians hope that this will allow the ovaries to then release an egg each month and make it easier to become pregnant.

In the past, you might've seen the best advice which recommended using the unlisted code (58679, Unlisted laparoscopy procedure, oviduct, ovary) and comparing the work to 49322 (Laparoscopy, surgical; with aspiration of cavity or cyst [e.g., ovarian cyst] [single or multiple]), but as stated above, the ob-gyns are not really aspirating cysts with this procedure; just making holes in the ovary to help promote fertility. However, this would be the closest code in terms of physician work.

Keep in mind that reporting 49322 with a diagnosis of PCOS (E28.2, Polycystic ovarian syndrome) could also result in a denial due to a CPT^®/ICD code mismatch. You should work with your payers to ensure that ovarian drilling is a covered surgery and to come up with appropriate billing to effect timely payment if it is. While ACOG continues to advise use of 58661 for this procedure because they argue it is like removing part of the ovary, CPT^® has issued instructions that a "close" code should not be assigned; instead you should report an unlisted code when a specific one is not available.