Wiki Please help!!

[TanBro]

I'm stuck and now I'm thinking was too much into it, so any help appreciated. My doc did a laparoscopic exam, after that the camera was removed and she went through vaginally. She then removed a pelvic mass through the vagina and then did a trachelectomy. I have 49320 for the lap exam and 57530 for the trachelectomy but I'm lost on the removal of mass through the vagina. Everything I come up with is laparoscopic. Ugh what am I missing here?

 

[bgrasson]

I'm stuck and now I'm thinking was too much into it, so any help appreciated. My doc did a laparoscopic exam, after that the camera was removed and she went through vaginally. She then removed a pelvic mass through the vagina and then did a trachelectomy. I have 49320 for the lap exam and 57530 for the trachelectomy but I'm lost on the removal of mass through the vagina. Everything I come up with is laparoscopic. Ugh what am I missing here?

I would not bill for the 49320 because it was converted to a vaginal procedure- I would bill 57135 for removal of cyst/tumor and 57530- if the mass is the remaining cervical stump then just bill for the Trach.

 

[TanBro]

I would not bill for the 49320 because it was converted to a vaginal procedure- I would bill 57135 for removal of cyst/tumor and 57530- if the mass is the remaining cervical stump then just bill for the Trach.

Thankyou so much. It was a separate mass and not a cervical stump.

 

[TanBro]

I would not bill for the 49320 because it was converted to a vaginal procedure- I would bill 57135 for removal of cyst/tumor and 57530- if the mass is the remaining cervical stump then just bill for the Trach.

One more question, sorry, I would use 57135 even though it was a pelvic mass and not vaginal cyst?

 

[bgrasson]

One more question, sorry, I would use 57135 even though it was a pelvic mass and not vaginal cyst?

yes because the code states tumor/cyst

 

[csperoni]

yes because the code states tumor/cyst

I'm not certain I agree with that in this situation.
57135 Excision of vaginal cyst or tumor
I interpret this as excision of a vaginal cyst or a vaginal tumor. This patient had neither. The mass/tumor was in the pelvis, not in the vagina or vaginal wall. It was simply that the procedure was performed through the vagina vs open or laparoscopic. I am not aware of an existing code to remove a PELVIC mass through the vagina. Depending on the documentation and perhaps a discussion with the provider for clarification about the amount of work this represented, I see 2 options:
1) Add -22 on your 57530 trachelectomy code.
2) Bill with unlisted. Comparison possibilities include 58662 or 49203.
I do agree that if you have a laparoscopic procedure converted to another access, you code the surgery the way it was completed, not the way it started.