Ob-Gyn Coding Alert

Question: A colleague recently told me that I should report a total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO), omentectomy and debulking for endometrial cancer as 58953. She also said I should use 58954 for a TAH, BSO, omentectomy, debulking and lymph node dissection for endometrial cancer. I thought there had to be some type of ovarian pathology to use these codes. Which is the case?

New York Subscriber

Answer: The AMA is moving toward removing diagnostic references in the CPT codes. Most likely, the codes' descriptors (58953, Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking; 58954, ... with pelvic lymphadenectomy and limited para-aortic lymphadenectomy) are a result of this.
 
Nonetheless, CPT clearly places these codes in its Ovary section. In addition, the AMA's CPT Changes 2003: An Insider's View states, "58953-58954 have been added in order to accurately describe the various combinations of ovarian cancer surgeries ... the new codes would apply to cancer of all three origins [ovarian, tubal and primary peritoneum]." Consequently, you should not use these codes when the surgery's purpose is endometrial unless the patient also has ovarian or tubal cancer.
 
Because there is no code for debulking except those referring to ovarian cancer, you will have to add a modifier -22 (Unusual procedural services) to the basic code, which will be one of the following (note that 58240 would include debulking by the procedure's very nature, so you would not use modifier -22 with this code):