The work is close to 49321 in my opinion, but as this was an removal of the vaginal cyst rather than a biopsy of it, you would have to report the unlisted code 49329 and compare the work to 49321. I would not report 58662 as this was a simple cyst on the vaginal cuff, not a growth on the pelvic viscera or peritoneal surface, This code has nearly twice as many relative value units because the expected work is much more difficult than described by your op note. But I have to say that this was not done using ultrasound guidance. He did an ultrasound to verify the location of the cyst before inserting the scope, but did not use ultrasound to guide the laparoscopic removal. I would bill a limited pelvic ultrasound for that part.