Ob-Gyn Coding Alert

Question: One of my physicians did a laparotomy and bilateral ovarian cystectomies on a patient who is 14 weeks pregnant. Should I code 51555 along with 49000-51 (exploratory laparotomy, exploratory celiotomy with or without biopsy[s] [separate procedure])?

New York Subscriber

Answer: Her pregnancy does not alter the codes you will use, but it makes the surgery that much harder, so you can append modifier -22 (unusual procedural services) to 58925 (ovarian cystectomy, unilateral or bilateral). The laparotomy is the look see and is never coded in addition to other procedures done abdominally. Code 51555 (cystectomy; complicated [e.g., postradiation, previous surgery, difficult location]) is not correct, because it represents the removal or excision of a bladder. Instead of looking in the ob/gyn section of CPT, it appears you looked in the urinary system section. This is a good example of why it is important to check the chapter headings. In this case a cystectomy can refer to either the excision of the the urinary bladder, the excision of the gallbladder (cholecystectomy) or the removal of a cyst (in ob/gyn, usually a cyst of the ovaries). Code 49000 is also incorrect because it is included with the surgical laparotomy.