Ob-Gyn Coding Alert

Reader Questions:

Question Whether Ob-Gyn Excised Ovarian Tissue

Question: I am hoping to get some advice coding this surgery. The ob-gyn performed laparotomy, de-torsion left ovary, left ovarian cystectomy, left salpingectomy. For the laparotomy, the ovary had a large cyst and was high in the abdomen. The ovary was de-torsed with three turns. The patient also had a large cystic structure that was removed and the left fallopian tube as well.

For potential codes, I was thinking 58700 for the left salpingectomy (ICD-10: N83.512, N83.8) and 58925 for the cystectomy (ICD-10: N83.292). Am I way off base here?

Tennessee Subscriber

Answer: You need to keep in mind the “separate procedure” designation on 58700 (Salpingectomy, complete or partial, unilateral or bilateral (separate procedure)). While these codes do not hit National Correct Coding Initiative (NCCI) edits, some carriers may not pay them together.

You should also check that your ob-gyn only removed the ovarian cyst without any ovarian tissue. If he excised the ovarian tissue, then it’s possible 58720 (Salpingo-oophorectomy, complete or partial, unilateral or bilateral (separate procedure)) is more accurate.

Depending on the amount of work involved in the ovary being high in the abdomen and what was required to detorse the ovary, you might consider modifier 22 (Increased procedural service). If the ob-gyn had to do a significant amount of additional work beyond what is described in the CPT® code descriptor, AND he thoroughly documented that, you can use modifier 22.

For ICD-10-CM: Code N83.512 (Torsion of left ovary and ovarian pedicle) seems correct. While code N83.292 (Other ovarian cyst, left side) is not necessarily incorrect, you shouldn’t use “other cyst” unless the ob-gyn describes the cyst in more detail somewhere else. You would use N83.202 (Unspecified ovarian cyst, left side) based on the very limited documentation provided, as the cyst is not described at all, other than knowing it’s on the left ovary.

What are you using N83.8 (Other noninflammatory disorders of ovary, fallopian tube and broad ligament) for? From the note above, the documentation states there is a left ovarian cyst and torsion. It is possible it is appropriate, but this would require more information.