Wiki General surgeon doing LSO...

[trinalankford]

My doc is doing an LSO for an ovarian cyst while he is doing an open left colectomy for cancer. I do not normally code OB-GYN, and I see 58720, but this is not a "separate procedure." I do not see any code for the LSO incidental to another procedure.

Thank you.

 

[colorectal surgeon]

I would go with that code. 58940 is the only other thing and that's incorrect since he removed the Fallopian tube as well.

 

[preserene]

I feel that along with colectomy code like 44140, reporting one of 49203-49205 would go for ovarian mass. The salpingectomy part would be bundled into this major surgical procedure. I would advice that if it takes more time and work then -22 can be appended.

 

[trinalankford]

I am going to include part of the op note (I didn't want to at first because I did not want to retype it):

The abdomen was entered. Appropriate retractors were placed. The sigmoid was mobilized using electrocautery, reflecting the sigmoid medially. The ureter was identified early in the procedure and protected throughout this procedure. The bowel was trransected using GIA AutoSuture at about the brim of the pelvis. The bowel was transected proximal to the tumor about 8 inches proximal to the tumor mass. The mesocolon was divided using the Surgilase. Hemostasis was judged complete. The resected specimen was handed off the field. The proximal end of bowel was brought into the pelvis where it was anastomosed side to side with the distal stump of bowel. The residual defect was closed with running 2-0 chromic on the mucosa and then interrupted 3-0 silk on the muscular layers.

Attention was turned to the upper abdomen where a tiny white granulomatous type plaque was scraped off the left lobe of the liver using a #15 blade scalpel...(so liver biopsy here but not percutaneous)

The gallbladder was then mobilized for removal....(open chole performed here).

Prior to closing the abdomen, the left ovarian cyst and fallopian tube were removed using the Surgilase...(this is literally all that is dictated about it). The abdomen was then irrigated......

So.....I have a left colectomy with anastomosis, open chole, liver biopsy, and LSO. I know the codes for the colectomy and open chole. The liver biopsy is questionable (because it was not a needle biopsy), and the LSO is still up in the air.