need help with surgery cpt codes

[rockylopez]

Pre-Op Diagnosis: pelvic fluid collection, failed IR drainage
Post-Op Diagnosis: multiple adhesions with bilateral hydrosalpinx
Procedure: diagnostic laparoscopy converted to exploratory laparotomy with lysis of adhesions, bilateral salpingectomy, appendectomy,
chromopertubation

Need help with CPT codes for procedures. Thank you

 

[csperoni]

It's always best to start with you indicating what you think the codes are/might be, or what you are debating/unsure of.

 

[rockylopez]

It's always best to start with you indicating what you think the codes are/might be, or what you are debating/unsure of.

Thanks so much for the reply. I am unsure if these are the correct codes and unfortunalty I do not have codify or encoder pro to confirm if these codes are in any way bundled.
49000 exp lap.

58661 bilateral salpingectomy

58350 chromopertubation

44960 appendectomy with rupture

 

[csperoni]

OK - now that we know where you're starting, I can provide some advice from here. BTW while Codify or Encoder Pro or any online encoder are the easiest ways to check NCCI edits, they are available for free thru CMS. There have been other posts providing the link/instructions if you search.

When a procedure starts as laparoscopic and converts to open, you code for the way the procedure itself was actually completed. Without the full note, I am assuming they started with laparoscopy, realized the adhesions would preclude safely completing it laparoscopic and opened. So, you would code for the open salpingectomy, open appendectomy at the time of another procedure, and POSSIBLY the chromopertubation. If they planned on removing both tubes (salpingectomy), I'm not clear why they would have performed a chromopertubation, which checks the patentcy of the tubes. Almost any exploratory laparotomy or exploratory laparoscopy are not coded when there is a more extensive surgery being performed. Of course the physician examined the abdomen before performing the surgery. I can't think of any situation where it's not bundled.

That leaves you with:
58700 salpingectomy
58350 chromopertubation (again assuming elsewhere in the full note explains an indication)
44955 for appendectomy (assuming there was an indication for it - none is provided in your original question, but you mention rupture in your follow up)