Infracolic omentectomy with Hysterectomy

natashalage

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Hello Coding Community, :)
I will greatly appreciate your help, expertise in the following scenario. I am not sure if I should also code -ectomy of Infracolic Omentectomy when Lap Vaginal Hysterectomy with BSO (tubes, ovaries) is done?
49255 is a Separate procedure and "is usually a component of a more complex service and is not identified separately. When performed alone or with other unrelated procedures/services it may be reported."
My pt had the above px 58552-Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) due to the ovarian mass ( cancer is not found).
Is Infracolic Omentectomy done for staging?.. It seems like it's a component of the major Px 58552 and I should not code it but.... I am a new coder.
However, NCCI allows me to bill for both: 58552 and 49329-Unlisted laparoscopy procedure, abdomen, peritoneum and omentum LIKE 49255-Omentectomy, epiploectomy, resection of omentum (separate procedure)
Thank you.
 

csperoni

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I do not believe unlisted codes are in NCCI edits since they do not have an exact description. My personal opinion (with 16 years gyn onc experience) is that if the procedure was open, the codes would be bundled, therefore I would not try to code separately for it with laparoscopic. If a code existed, I'm pretty certain it would be an edit. I also would not consider this staging since there was no cancer diagnosis.
If the note and documentation warrants it, you could consider modifier -22 on your hysterectomy code.
PS - it depends on your surgeon, but make sure you are not confusing a laparoscopic assisted vaginal hysterectomy (5855_) with a laparoscopic total hysterectomy (5857_). If the surgery is all done through the ports, simply removing the specimen through the vagina, that alone does not make it laparoscopic assisted vaginal hysterectomy. For my surgeons, it's almost unheard of to do vaginal anymore unless there is also a prolapse or other medical issue.
 

natashalage

Networker
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Dear Christine,
Thank you very much for your thorough explanation! Everything you said, makes sense now. Many of us read your responses to this forum and we, all, learn a lot from your experience! Thank you. :)
 
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