Ob-Gyn Coding Alert

Question: We perform resection of ovarian malignancies (58952) quite often. The Correct Coding Initiative (CCI) does not list the lymphadenectomy codes 38770 or 38780 as a component of 58952. Codes 38770 and 38780 are listed as separate procedures but since they are not components of 58952, can we bill for the lymphadenectomy as well as the debulking code?

Michigan Subscriber

Answer: You may code for the lymph node removal separately because 58952 only includes resection of the tumor, bilateral salpingo-oophorectomy, omentectomy and radical debulking (i.e., removing as much of the tumor bulk as possible). But because the codes for pelvic lymphadenectomy and retroperitoneal transabdominal lymphadenectomy are separate procedures, you will probably need to add a modifier -59 (distinct procedural services) to 38770 and 38780 to bypass any bundling edits. The American College of Obstetricians and Gynecologists coding manual also includes the information that lymphadenectomy can be reported with 58952. Note, however, that lymph node sampling should not be coded separately when billing 58952.