Wiki Laparoscopic oophorectomy with pelvic masses excision

[such78]

Patient had a history of uterine fibroids, status post hysterectomy with bilateral salpingectomy.

In pathology report:
1. corpus luteum cysts
2. left & right pelvis masses as cellular leiomyoma.

Surgeon did laparoscopic bilateral oophorectomy and resected multiple masses, several approximately 5-7 cm from right side wall, left side wall, and larger lesions in the left side and in the mid pelvis.

Is CPT 58661 - laparoscopic bilateral oophorectomy included pelvic masses(leiomyoma) excision , or 58545/58546 also needs to assign with 58661?


Thank you for advice.

 

[csperoni]

58545 Laparoscopy, surgical, myomectomy, excision; 1 to 4 intramural myomas with total weight of 250 g or less and/or removal of surface myomas 58546 Laparoscopy, surgical, myomectomy, excision; 5 or more intramural myomas and/or intramural myomas with total weight greater than 250 g
If the patient already had a hysterectomy (removal of uterus), she can't possibly have intramural or surface myomas (fibroids) and can't have a myomectomy. Here's a good reference from ACOG about fibroids. https://www.acog.org/womens-health/faqs/uterine-fibroids This eliminates the possibility to use 58545/58546.

58662 Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method 58662 sound much closer to what was done. While it is not a CCI edit, many insurances will want to bundle 58662 and 58661. The op note should clearly indicate the separate work of removing the masses vs removing the ovaries so you can justify on appeal.

Alternately, you could consider 58661-22. Again, the op note should indicate the additional work of removing the masses.

 

[such78]

Thank you, Christine.