Ob-Gyn Coding Alert

Question: Should I bill 58661 with modifier 50 for an ovarian cystectomy involving both ovaries, or does 58661 include both ovaries?

California Subscriber

Answer: The answer depends on how the ob-gyn treated the cyst.

You should only bill 58661 (Laparoscopy, surgical; removal of adnexal structures [partial or total oophorectomy and/or salpingectomy])) when the ob-gyn removes part of the ovary with the cyst (despite that the CPT® index refers you to this code when you look up the term "cystectomy, ovary").

If the ob-gyn aspirates a cyst, the code would be 49322 (... with aspiration of cavity or cyst [e.g., ovarian cyst] [single or multiple]), no matter how many cysts the ob-gyn aspirates.

If the ob-gyn removes the cyst intact without removing a part of the ovary, you should bill 58662 (...with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method]) which does not take modifier 50 (Bilateral procedure).

Careful: If 58661 is the code you will be reporting for the cystectomy, you should know that in 2007, the CPT® Assistant published that 58661 does not take a modifier 50 (despite saying it did back in 2002). But also in 2007, Medicare changed their mind and now allows a modifier 50 on 58661. So it all depends on which rule set you are following currently.