Oncology & Hematology Coding Alert

When CPT added surgical codes to permit gyn oncologists to report two common combinations when operating on ovarian and related cancers, confusion reigned among coders and physicians.

The additions help oncologists obtain accurate reimbursement for cancer surgeries that had lacked uniquely descriptive codes. However, the bundled edits, which arrived hard on the heels of the new codes, have kept everyone on their toes. Nevertheless, "I think these are really good codes," says Melanie Witt, RN, CPC, MA, an independent coding consultant and educator based in Fredericksburg, Va., because until 2002, no code dealt with both abdominal hysterectomy and radical dissection. New Codes Pay for Real Work The original code 58950 (Resection of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy) was paired with two indented procedures 58951 (... with total abdominal hysterectomy, pelvic and limited para-aortic lymphadenectomy) and 58952 (... with radical dissection for debulking) that were used separately to address total hysterectomy and lymphadenectomy, and radical dissection. The proper codes now follow under the heading Ovary, Excision in the CPT book CPT book: 58953 Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking 58954 ... with pelvic lymphadenectomy and limited para-aortic lymphadenectomy. For example, a patient with advanced-stage uterine cancer undergoes a hysterectomy, and during the same operating session the surgeon takes out the ovaries and tubes, removes the omentum and does some radical dissection for debulking. As written, code 58953 can and probably should be used, say Michael Berman, MD, FACOG, FACS, SGO liaison to the ACOG committee on coding and nomenclature and professor of obstetrics and gynecology at the University of California, Irvine. The American College of Obstetrics and Gynecology (ACOG) requested these specific codes because frequently the physician was doing both procedures and reporting 58950 with 58951 or 58952, but "they were getting rejected because a lot of payers interpreted CPT such that the top code included the indented ones below it," Witt says.

With the present codes, the physician work in ovarian cancer surgery which is usually more involved than a simple removal of the uterus, Witt says can be properl reimbursed. RVUs for these codes are high but justifiable because these procedures are also serious surgery. For example, 58953 and 58954 carry RVUs of 50.79 and 55.21 respectively, while 58951 and 58952 are valued at 36.39 and 40.50. Remember, Witt says, if you report one of these two codes, you never report the old codes as well. CPT has expanded not replaced the original codes because they were insufficient to describe all of the work done by the physician. CCI 8.3 Punctures the Balloon The October 8.3 CCI edits have created [...]