Ob-Gyn Coding Alert

Question: The patient had an exploratory laparotomy and surgical debulking of ovarian cancer. But the ob-gyn takes out a right sidewall tumor, bladder tumor and rectosigmoid tumor and does an omental biopsy. I was going to use 58925, but what should I use for the rest? The pathology on these indicates residual mature cystic teratoma for all submitted specimens, but the op report does not mention that. The op note lists a post-op diagnosis of a recurrent stage-3 ovarian cancer, and the surgeon found a 5-cm bulk of tumor on the right pelvic sidewall, a small amount of seeding along the right pelvic sidewall, and a 3-cm tumor in the rectosigmoid serosa.


Tennessee Subscriber


Answer: You seem to be mixing the diagnosis coding with the CPT procedures. Although the physician indicates recurrent cancer, ICD-9 leads you to report a benign lesion for a diagnosis of mature cystic teratoma. In this case, you will need to consult with your surgeon to point out this apparent discrepancy. 

As for the procedure, 58925 is the code for an ovarian cystectomy, but this is not the procedure the physician performed.

All of the tumors listed above were excised, but while the physician indicated that he performed surgical debulking of ovarian cancer, none of the debulking codes for ovarian cancer apply here because the ob-gyn has already done the hysterectomy and removed the ovaries.

So you are left with 49200 (Excision or destruction, open, intra-abdominal or retroperitoneal tumors or cysts or endometriomas) or 49201 (- extensive) for this surgery.