Wiki Laparoscopic trachelectomy with removal of pelvic mass Please help!!

[TanBro]

My Doc performed a laparoscopic trachelectomy with removal of pelvic mass. The only code that would be close that I see is 57550 with code 58545. Pelvic mass was a leiomyoma. I'm lost!! The op note says the cervix/mass was removed through the vagina but also done laparoscopically. Supracervical hysterectomy in 2011. PLEASE HELP!!

 

[csperoni]

How the cervix/mass was removed does not determine the coding. How they performed the procedure (ligating ligaments, arteries, structure, etc) determines this.
If they performed the procedure laparoscopic through abdomen ports, then simply removed through the vagina, this is a laparoscopic procedure. If they performed the procedure through the vagina using laparoscopic tools (vNOTES procedures), then it is a vaginal procedure.
57500 is definitely incorrect - they removed the entire cervix which is so much more work than a biopsy of the cervix.
58545 would be correct IF the procedure was done laparoscopic and the leiomyoma was on the uterus. As the patient already had her uterus removed, this does not seem to be the case. It sounds like you are describing they previously removed her uterus but somehow left behind a fibroid? I suppose it's possible, but nothing I've ever come across.

Assuming the procedure was laparoscopic, there is no code for a laparoscopic trachelectomy. You must use unlisted 58578 with comparison to 57530 or 57550.

For the leiomyoma removal, I would clarify through records or query to clinician this was a fibroid in the pelvis even though uterus was previously removed. If not, perhaps 58662 is appropriate?? If yes, 58545 just does not seem correct. Either 58545-52 or another unlisted (unlisted laparoscopic abdominal 49329).

If procedure was actually vaginal, suggestions above do not apply.

I'd love to hear any other suggestions on this. This might be a good case to submit to ACOG for confirmation.

 

[TanBro]

How the cervix/mass was removed does not determine the coding. How they performed the procedure (ligating ligaments, arteries, structure, etc) determines this.
If they performed the procedure laparoscopic through abdomen ports, then simply removed through the vagina, this is a laparoscopic procedure. If they performed the procedure through the vagina using laparoscopic tools (vNOTES procedures), then it is a vaginal procedure.
57500 is definitely incorrect - they removed the entire cervix which is so much more work than a biopsy of the cervix.
58545 would be correct IF the procedure was done laparoscopic and the leiomyoma was on the uterus. As the patient already had her uterus removed, this does not seem to be the case. It sounds like you are describing they previously removed her uterus but somehow left behind a fibroid? I suppose it's possible, but nothing I've ever come across.

Assuming the procedure was laparoscopic, there is no code for a laparoscopic trachelectomy. You must use unlisted 58578 with comparison to 57530 or 57550.

For the leiomyoma removal, I would clarify through records or query to clinician this was a fibroid in the pelvis even though uterus was previously removed. If not, perhaps 58662 is appropriate?? If yes, 58545 just does not seem correct. Either 58545-52 or another unlisted (unlisted laparoscopic abdominal 49329).

If procedure was actually vaginal, suggestions above do not apply.

I'd love to hear any other suggestions on this. This might be a good case to submit to ACOG for confirmation.

It was a large pelvic mass arising from the cervix (345gm) It was done Laparoscopic. So, would I do the unlisted code and 58662? Thank you so much for your help! I really appreciate it!

 

[Cmama12]

It was a large pelvic mass arising from the cervix (345gm) It was done Laparoscopic. So, would I do the unlisted code and 58662? Thank you so much for your help! I really appreciate it!

Well, if the mass was attached to the cervix, then it's removal would be part of the trachelectomy. If it was a separate mass, then I would use 58662 for the mass as Christine suggested, with the unlisted for the lap trachelectomy.

 

[TanBro]

Well, if the mass was attached to the cervix, then it's removal would be part of the trachelectomy. If it was a separate mass, then I would use 58662 for the mass as Christine suggested, with the unlisted for the lap trachelectomy.

I was thinking it was included but was not 100% sure, first trachelectomy. I'm going to use the unlisted code, just not sure what code for price I compare it to. 57530 or 57550? Also would I include a 22 with the fibroid being so big?

 

[csperoni]

Ok - so it seems like what we have here is a laparoscopic trachelectomy. There was also a large mass attached to the cervix that was removed when the cervix was removed.
58578 unlisted laparoscopic procedure on the uterus.
You should never apply -22 (or -50, -52, -53, or several other modifiers) to any unlisted code. When you bill an unlisted, you need to come up with a code to compare it to. Usually it's best to come up with a code that would be a 1:1 comparison. Something where you can say - CPT999 is very similar to procedure CPT123, so pay the same amount. Sometimes you cannot really find a 1:1 comparison. In that case, you would say CPT999 is similar to CPT123, but 40% more work, so pay me 140% of CPT123. Or whatever percentage is appropriate for the specific case. It can be helpful to include the physician in that determination of a comparison code and percentage of additional work.