Billing 58662 with 58661

ltingle1

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Hello,

Our insurance girls have been receiving denials for 58661 being bundled with 58662. The MDs are performing salpingectomies/oophorectomies with ovarian cyst removal or ablation of pelvic endometriosis. Can I put a 59 modifier on the 58661 to get it paid or is that not allowed?
Thanks in advance!

- Lauren
 

csperoni

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-59 seems appropriate if they are doing additional work. My supercoder does not show them as CCI edits, so -59 should not be needed, but a private payor may have their own policy of bundling the codes.
 

ltingle1

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-59 seems appropriate if they are doing additional work. My supercoder does not show them as CCI edits, so -59 should not be needed, but a private payor may have their own policy of bundling the codes.
Thank you so much!
 

csperoni

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58660 is a column 2 (never allowed) CCI edit for both 58661 and 58662. The insurance should not have paid separately for 58660 in the first place.
If the lysis of adhesions are significant (> 1 hour) and described in the op note, I bill the primary procedure with -22 modifier and prepare an appeal letter.
 

natashalage

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I am a new coder and learning a lot from different sources. I am puzzled by one scenario: it's possible to bill 58661 and 58662 together When MD excised the lesions on the Right and Left ovaries And then partially removed Right and Left ovaries? I think if he removed partial ovary then only 58661 should be billed and not both codes. I just logically cannot understand it. Will greatly appreciate your help.
 

csperoni

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Just to clarify your situation, the provider first excised lesions (58662) and then separately removed part of both ovaries (58661-50)?
OR, did he need to remove small parts of the ovaries attached to the lesions??
OR, did he need to remove the ovaries, and there happened to be lesions??
If it is scenario 1, then both codes seem appropriate, but I would be skeptical of that.
For scenario 2, I would likely bill 58662-22 as it was a lesion removal that was complicated/complex.
Scenario 3, 58661-50 if the intention is removal of the ovaries, and incidentally there was a lesion attached to the ovary.
I am also assuming this is entirely laparoscopic, even though it's not stated.
Hope even some of that helps.
 

natashalage

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Thank you so much for your help, Csperoni. I love learning and strive to become an excellent coder= it’s fun. So, what I understood from this report that both ovaries are multicystic. MD excised cysts on Right at posterior cut-de-sac and another cyst on Left at superior to uterus =59662-50. Is that right?
Next, MD did partial resection of both ovaries = 59661-50. Is that right?
What I don’t understand which parts he removed: the ones with cyst or separately identifiable parts of ovaries(different from the areas 59662), in addition to 59662?
If MD removed the parts that contained those cysts, then we code only 59661, correct?

Procedure performed: Bilateral laparoscopic cystectomy and partial oophorectomy

Indications: recurrent symptomatic enlarged cystic ovaries. Cytology had previously been sent on vaginally aspirated cyst fluid and confirmed benign nature as did prior pathology from laparoscopy x 2 with ovarian cystectomy.
Findings:
On laparoscopy, ovaries were bilaterally multicystic and enlarged--the left was 8cm and superior to the uterus and the right was 10+cm and in the posterior cul-de-sac.
Procedure: …..
At the umbilicus, the skin was infiltrated with marcaine. A 5 mm vertical incision was made I….. followed by the 5 mm 0 degree laparoscope. ….. A5 mm port and a 10mm port were placed in the right and left lower quadrants respectively, both under direct visualization.
Attention was turned to the left ovary. A laparoscopic needle on a syringe was used to aspirate the majority of the cyst fluid from the largest cysts, a sample of which was sent for cytology. Roughly half of the ovary was then resected with the ligasure cautery. The cyst wall from the largest cyst was also removed. The sample was removed from the body using a 11mm endocatch bag and sent to pathology. Attention was then turned to the right ovary where a similar process was repeated. The sample again was removed from the body in a 11mm endocatch bag and sent to pathology.
The ovaries were returned to their anatomic positions and the abdominal cavity was irrigated with warm fluid. ….. The Foley catheter was removed…
Specimens: cyst fluid from left and right ovarian cyst; portion of left and right ovary
 

csperoni

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From what I am reading, this appears to be a partial removal of both left and right ovaries, with attached cyst wall. He aspirated the fluid, but did not separately remove the cysts. I would code this as 58661-50. I added some comments to your post below (my responses in purple italic bold).

Thank you so much for your help, Csperoni. I love learning and strive to become an excellent coder= it’s fun. So, what I understood from this report that both ovaries are multicystic. MD excised cysts on Right at posterior cut-de-sac and another cyst on Left at superior to uterus =59662-50. Is that right?
1) I think you mean 58662-50, not 59662-50. However, 58662-50 is not correct for 2 reasons. First, -50 is not a valid modifier for that code. Second, I do not see where in this op note the physician performed an ovarian cystectomy. The op note is slightly vague, but appears to indicate the cyst was aspirated, then wall was removed while the ovary was resected. 49322 is a column 2 code with 58661 and -59/-XU does not seem appropriate to me. Under specimens removed, it does not state cysts. Sometimes looking at the pathology report can help. If pathology report indicated separate specimens of cyst (not just fluid) and portions of ovaries, I would query the physician further. The size and location provided appears to be of the ovaries, not of the cysts. ie "left [ovary] was 8cm and superior to the uterus and the right [ovary] was 10+cm and in the posterior cul-de-sac.
Next, MD did partial resection of both ovaries = 59661-50. Is that right?
2) I think you mean 58661-50, not 59661-50, in which case I agree.
What I don’t understand which parts he removed: the ones with cyst or separately identifiable parts of ovaries(different from the areas 59662), in addition to 59662?
If MD removed the parts that contained those cysts, then we code only 59661, correct?

Procedure performed: Bilateral laparoscopic cystectomy and partial oophorectomy

Indications: recurrent symptomatic enlarged cystic ovaries. Cytology had previously been sent on vaginally aspirated cyst fluid and confirmed benign nature as did prior pathology from laparoscopy x 2 with ovarian cystectomy.
Findings:
On laparoscopy, ovaries were bilaterally multicystic and enlarged--the left was 8cm and superior to the uterus and the right was 10+cm and in the posterior cul-de-sac.
Procedure: …..
At the umbilicus, the skin was infiltrated with marcaine. A 5 mm vertical incision was made I….. followed by the 5 mm 0 degree laparoscope. ….. A5 mm port and a 10mm port were placed in the right and left lower quadrants respectively, both under direct visualization.
Attention was turned to the left ovary. A laparoscopic needle on a syringe was used to aspirate the majority of the cyst fluid from the largest cysts, a sample of which was sent for cytology. Roughly half of the ovary was then resected with the ligasure cautery. The cyst wall from the largest cyst was also removed. The sample was removed from the body using a 11mm endocatch bag and sent to pathology. Attention was then turned to the right ovary where a similar process was repeated. The sample again was removed from the body in a 11mm endocatch bag and sent to pathology.
The ovaries were returned to their anatomic positions and the abdominal cavity was irrigated with warm fluid. ….. The Foley catheter was removed…
Specimens: cyst fluid from left and right ovarian cyst; portion of left and right ovary
 

natashalage

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Dear Chistine,
Thank you very much for your help with my excision and resection of ovaries question! I am so glad that we, junior coders, have professional and experienced coders like You!
p.s per pathology report, it was fluid; therefore, it's a drainage.
Thank you. :)
 

suchang78

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Fallopian tube and ovary laparoscopic removal, correct reporting
CPT Assistant, May 2010 Page: 10 Category:

Surgery: Female Genital System

Question:

If a surgeon performs a laparoscopy with bilateral removal of ovaries and/or fallopian tubes, should code 58661, Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy), be reported with Modifier 50, Bilateral procedure,appended? Is the laparoscopy procedure described by code 58661 considered inherently bilateral?

Answer:

Code 58661 describes a bilateral procedure, which includes the excision and removal of tubes and/or ovaries, by any method. Therefore, if a laparoscopy and bilateral removal of ovaries and/or fallopian tubes are performed, it would not be appropriate or necessary to append Modifier 50 to indicate the procedure was performed bilaterally.(1) In addition, if the surgeon performs a laparoscopy with removal of an ovary and/or fallopian tube on one side, code 58661 would still be reported without modification. (2) Also, when this procedure is performed unilaterally, it is not necessary to report modifier 52, Reduced Services. The word "or" between "partial or total" within the descriptor of code 58661 indicates this already.
 
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