nsteinhauser
Expert
Op report:
"A 5 mm Visiport was advanced through the abdominal wall using direct visualization with the laparoscope. Intraperitoneal placement was confirmed. A second 5mm port was placed under direct visualization in the LLQ. A 8mm port was placed suprapubically under direct visualization. Local anesthesia was injected prior to this. The IUD was visualized in the RLQ with a small adhesion to the right broad ligament. This was removed bluntly, and the IUD was removed via the LLQ port. The right fallopian tube was grasped. The harmonic was marched down the mesosalpinx, and the fallopian tube was amputated at the cornua. In the process, there was a small rent in the utero-ovarian ligament. This was made hemostatic with the harmonic. Attention was then turned to the left fallopian tube. The distal half of the fallopian tube was able to be removed using the harmonic. The rest was left intact due to the dense adhesions.
The left ovarian cyst ruptured spontaneously during this process. The hole in the cyst wall was made larger with laparoscopic scissors. Attempts were made to dissected the cyst wall away from the ovarian stroma. Unfortunately, the cyst wall was too densely adhered to be removed intact. Small pieces were able to be taken off bluntly. The harmonic was used to make the ovary hemostatic and a small amount of additional cyst wall was removed in the process. Attention was then turned to the right ovarian cyst which was partially excised in a similar fashion. Arista was applied for additional hemostasis."
I come up with 58661 for tubal and 58662 for removal ovarian cysts (partial). I've previously read that you can't code for 2 surgeries like this together if removals were done by same physician at the same surgical setting through the same ports. I can't locate that info right this minute, but does that 'rule' only apply if the surgeries are labeled as a "separate procedure"?. Neither 58661 nor 58662 are labeled as separate procedures. And as of this quarter, there aren't any NCCI edits for coding them together. But that doesn't make it right. Since the ovarian cysts are attached to the ovaries and they are part of the anatomical structures included in the 58661, then does 58661 include it all? Same with the malpositioned IUD. If it's removed during the same surgery, albeit from maybe an additional port, would it still be bundled into the other(s)? Or could you code a 49329 unlisted for the lap removal of the IUD?
Any thoughts would be appreciated. Thank you.
"A 5 mm Visiport was advanced through the abdominal wall using direct visualization with the laparoscope. Intraperitoneal placement was confirmed. A second 5mm port was placed under direct visualization in the LLQ. A 8mm port was placed suprapubically under direct visualization. Local anesthesia was injected prior to this. The IUD was visualized in the RLQ with a small adhesion to the right broad ligament. This was removed bluntly, and the IUD was removed via the LLQ port. The right fallopian tube was grasped. The harmonic was marched down the mesosalpinx, and the fallopian tube was amputated at the cornua. In the process, there was a small rent in the utero-ovarian ligament. This was made hemostatic with the harmonic. Attention was then turned to the left fallopian tube. The distal half of the fallopian tube was able to be removed using the harmonic. The rest was left intact due to the dense adhesions.
The left ovarian cyst ruptured spontaneously during this process. The hole in the cyst wall was made larger with laparoscopic scissors. Attempts were made to dissected the cyst wall away from the ovarian stroma. Unfortunately, the cyst wall was too densely adhered to be removed intact. Small pieces were able to be taken off bluntly. The harmonic was used to make the ovary hemostatic and a small amount of additional cyst wall was removed in the process. Attention was then turned to the right ovarian cyst which was partially excised in a similar fashion. Arista was applied for additional hemostasis."
I come up with 58661 for tubal and 58662 for removal ovarian cysts (partial). I've previously read that you can't code for 2 surgeries like this together if removals were done by same physician at the same surgical setting through the same ports. I can't locate that info right this minute, but does that 'rule' only apply if the surgeries are labeled as a "separate procedure"?. Neither 58661 nor 58662 are labeled as separate procedures. And as of this quarter, there aren't any NCCI edits for coding them together. But that doesn't make it right. Since the ovarian cysts are attached to the ovaries and they are part of the anatomical structures included in the 58661, then does 58661 include it all? Same with the malpositioned IUD. If it's removed during the same surgery, albeit from maybe an additional port, would it still be bundled into the other(s)? Or could you code a 49329 unlisted for the lap removal of the IUD?
Any thoughts would be appreciated. Thank you.
