Reimbursement Advisor

Ovarian detorsion: Limited coding options

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Q I performed surgical treatment for torsion of the ovary using the following procedures: diagnostic laparoscopy, exploratory laparotomy, detorsion of left tube and ovary, bivalve of left ovary, and left oophoropexy.

Two coding scenarios have been suggested: The first is 58925 (Ovarian cystectomy, unilateral or bilateral) 58825 (Transposition, ovary[s]), and 49320 (Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen[s] by brushing or washing). I hesitate to use these, though, since an ovarian cystectomy was not performed and the tube and ovary were detorsed, not transposed elsewhere.

The second option is 49000 (Exploratory laparotomy, exploratory celiotomy with or without biopsy[s]) with modifier -22 (unusual procedural services), plus 49320.Are these appropriate?

A The diagnostic laparoscopy, presumably performed to evaluate the problem, can be coded as 49320—but be aware that you may not receive reimbursement if you planned to do the surgery laparoscopically, then converted to an open procedure.

The exploratory laparotomy is not separately bil lable, since you’ll be billing for open surgical procedures. When this happens, the exploratory becomes integral to the surgical technique.

Next is detorsion of the left ovary: CPT does not have a code for this.

You then bivalved the ovary, which is analogous to performing a wedge resection, code 58920 (Wedge resection or bisection of ovary, unilateral or bilateral).

Finally, for the oophoropexy, you are correct that code 58825 is not applicable. If you had moved the ovary out of harm’s way due to radiation treatment, the procedure is referred to as transposition of the ovary and 58825 is reported. In this case, however, I’m guessing you sutured the ovary in place so it can no longer twist. Like the detorsion, CPT has no code for this.

Your coding options are limited, but I would suggest 58920-22—which covers the bivalving, detorsion, and oophoropexy—plus 49320-59 for the diagnostic laparoscopy. (The “distinct procedure” modifier indicates that the laparoscopy was not integral to the rest of the procedure.)

As far as diagnosis, the code linked to 58920 is 620.5 (Torsion of ovary, ovarian pedicle, or fallopian tube), or 752.0 (Congenital anomalies of ovaries) if you know the problem is congenital. Consider a different diagnosis for the laparoscopy, such as lower quadrant abdominal pain (789.03 or 789.04) or ovarian pain (625.9). Finally, add V64.41 to indicate the conversion from laparoscopy to an open procedure.

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