Wiki Help! - endometriosis via laparoscopy

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Jamie Dezenzo

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fulgrated endometriosis via laparoscopy 58662 and then ovarian drilling was then performed on the right ovary due to the sclerotic changes that were evident and there was clear fluid that was removed.

This completed the procedure. The CO2 was removed, as were the laparoscopic instruments.

58679 (unlisted) compare to 58970 for the ovary drilling??? thanks!
 
This is from "Pink Sheets" March 2009:

Unlisted code your best bet
for open ovarian drilling
Question: The ObGyn uses Endoshears and cautery
on each ovary to drill six small holes in each ovary
and also release some fluid from polycystic cysts. A
total abdominal hysterectomy also was performed.
I am not sure whether to report the procedure with
58805 (drainage of ovarian cysto, unilateral or
bilateral [separate procedure]; abdominal approach)
because the description states that the fluid is removed,
but in this case the fluid was only allowed to drain and
was not aspirated from the cavity.
Answer: Ovarian drilling also is known as ovarian
electrocautery, which is a form of fulguration (def:
the destruction of tissue, usually malignant tumors,
by means of a high-frequency electric current applied
with a needlelike electrode). Based on the information
given, we can assume the ovarian drilling was
performed via an open approach, since a TAH also was
performed. Therefore, even though ovarian drilling is
most typically performed laparoscopically, code 58662
(laparoscopy, surgical; with fulguration or excision
of lesions of the ovary, pelvic viscera or peritoneal
surface by any method) does not apply in this case,
since the approach wasn't laparoscopic. Note: For laparoscopic
ovarian drilling, ACOG recommends 58662
(http://suse.acog.org/pipermail/coding/2007/000012.
html).
One possibility is 58805, but unfortunately, this
code is generally understood to include aspiration of
the fluid in the ovary, but in the reader's case, the fluid
was released (i.e., drained), but not aspirated. Also
note that 58805 is classified as a separate procedure
in CPT, which means that when it is reported with
another procedure performed in the same general anatomic
area, it's included and won't be paid separately.
In this case, therefore, you should consider reporting
unlisted code 58999 (unlisted procedure, female
genital system [nonobstetric]) for the ovarian drilling.
Another alternative is 49203 (excision or destruction,
open, intra-abdominal tumors, cysts or endometriomas,
1 or more peritoneal, mesenteric or retroperitoneal primary
or secondary tumors; largest tumor 5 cm diameter
or less).
 
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