Wiki 49322 vs 58679

[bag4498]

Can someone please settle the debate. What code do you use for Laparoscopic incision and drainage of an ovarian cyst? No tissue removed. The dr. just goes in, punctures the cyst and it drains. I've found something that says aspiration and drainage are used simultaneously in this scenario https://canwecodethis.wordpress.com/2014/05/14/avoid-ovarian-cyst-cpt-errors-with-2-helpful-tips/. However, if I were to go through 3M, it leads me to the unlisted code 58679. Please help.

 

[thomas7331]

I guess it's technically not an aspiration the physician is just puncturing the cyst. I'm thinking that's probably why 3M is recommending the unlisted code, but I can't find any reference to support it. From my past experience, 3M is excellent about responding to inquiries and usually has well-researched rationale for all of their encoder logic. If you call them or go to their website and an open a ticket, I would imagine you'd get a prompt response back from them with additional information.

 

[csperoni]

I would have coded laparoscopic incision & drainage of a cyst as 49322 without even giving it a second thought. I've never used 3M.
When I do give it a second thought, I do see how 49322 specifies aspiration and the full description in codify states "withdraws fluid" and "suction", so I can understand the rationale for unlisted, just don't necessarily agree with it. You use unlisted when no other CPT accurately describes the service. I feel 49322 is 99% accurate.
I highly recommend ACOGs ask a coding question. If your doc is an ACOG member, you can register and it's free to ask up to 3 questions per month. They state 1-3 weeks for an answer, but I've never had it take even a full week. To me, their advice is the holy grail. If ACOG told me unlisted 58679, that's what I would do, comparing to 49322. In absence of that, I would use 49322.