Ob-Gyn Coding Alert

Question: I am in need of some assistance with choosing a CPT® code for what the provider indicates as a “laparoscopic ovarian vein cauterization.” The operative report indicates moderate to severe pelvic congestion syndrome.

The operative note states: “We began by first treating all the ovarian cysts by drainage and cautery, followed by ovarian drilling bilaterally, followed by serially cauterizing the ovarian vein as it fused into the IP and at the uteroovarian ligament. We reduced the volume of the ovarian vessels estimated at what looked like about a third on each side with cautery, being well aware of where the ureter was at all times.” How should I report this?

Alabama Subscriber

Answer: The American Congress of Obstetricians and Gynecologists (ACOG) recommends that ovarian drilling be coded as 58661 (Laparoscopy, surgical; with removal of adnexal structures [partial or total oophorectomy and/or salpingectomy]), but some experts disagree. The work your ob-gyn performed is closer to the work of 49322 (Laparoscopy, surgical; with aspiration of cavity or cyst [e.g., ovarian cyst] [single or multiple]) since the drilling basically is an aspiration procedure in multiple areas of the ovary.

The ovarian vein part of the procedure for the pelvic congestion syndrome has no code, so you can either go with:

• the unlisted code 58679 (Unlisted laparoscopy procedure, oviduct, ovary) (but you have to give the payer a comparison code. so they can agree with your fee) or
• add a modifier 22 (Increased procedural service) to 58661 or 49322.

Watch out: Usually, the drilling is done for PCOS (256.4, Polycystic ovaries), not PCS (625.5, Pelvic congestion syndrome), so if you use PCS as your only diagnosis, you may have a coverage issue.

ICD-10: When your diagnosis system changes, you should report E28.2 (Polycystic ovarian syndrome) instead of 256.4 and N94.894 (Other specified conditions associated with female genital organs and menstrual cycle) instead of 625.5.