You can post a question only up to 7 days from the date of the webinar.
You can continue to post comments and stay informed, compliant, and profitable.
Close
This session has expired.
Register for our upcoming webinars & continue to get coding, compliance & reimbursement updates.
Close

Post

Vote
0
2 Followers Follow
Posted By Maria on 04-03-2019, 13:55:49 in Ob-Gyn
Hello Melanie,

I need some CPT help, please.

Dr has 58720 and 38571. 38571 is laparoscopic. So that is out.

So then 58720 and 38770

He did much more than just a RSO,. Possibly mod 22?

But I was wondering how about 58958 with 38770/59?

Her cancer is recurrent and the lay description seems close.

But I am uncertain in which codes would be best.

Thanks so much.


PREOPERATIVE DIAGNOSIS:
Recurrent cervical cancer
 
POSTOPERATIVE DIAGNOSIS:
Same
 
OPERATION:
1. Exploratory laparotomy
2. Right salpingoophorectomy
3. Right pelvic lymphadenectomy
4. Debulking of right side wall tumor
 
ANESTHESIA:
General
 
ESTIMATED BLOOD LOSS:
200 mL
 
INDICATIONS:
31 yo with recurrent cervical cancer in right pelvic sidewall here for OR removal.
 
FINDINGS:
Mass noted low in obturator area on the right. Extensive adhesions of the iliac vessels and ureter to pelvic sidewall. Complete obliteration of the right pelvic sidewall.
 
SPECIMEN:
Right fallopian tube and ovary, right pelvic lymph nodes, right pelvic sidewall biopsies
 
 
PROCEDURE:
After assuring informed consent the patient was taken back to the operating suite and induction of general anesthesia was done. The patient was placed in the modified dorsal lithotomy position in Allen stirrups then prepped and draped in the normal sterile fashion.
 
A midline vertical skin incision was made from the symphysis pubis to up around the umbilicus. The incision was carried down to the fascia with the bovie cautery. The fascia was then incised and the incision was extended superiorly and inferiorly. The rectus muscles were separated in the midline. The peritoneum was identified and entered sharply, then carried superiorly and inferiorly with good visualization of the bladder.
 
The bookwalter retractor was then placed and attention was turned to the pelvis. The bowel was then packed back and attention was taken to the pelvis. The right retroperitoneum was then entered. The pararectal and paravesical spaces were opened minimally due to extensive fibrosis, adhesions of the pelvic sidewall. The right infundibulopelvic ligament were clamped and cauterized and cut with a ligasure. The broad ligament was taken down and the ovary was removed. The right external iliac lymph nodes were then removed with the margins of resection being the genitofemoral nerve laterally, the ureter medially, midportion common iliac artery superiorly and distal circumflex iliac vein inferiorly. The mass noted in the wall was attempted to be dissected out and the area was stuck. We debulked as much as possible and then consult was done by Dr. Lulek and biopsies of this mass and opening of the obturator area was done. The entire mass was unable to be removed due to dense adhesions of the vessels and further dissection would have created a major vascular injury. It was decided to stop the dissection here.
 
The pelvis was thoroughly irrigated and found to be hemostatic. Surgicel and floseal was placed in the pelvis. Seprafilm was placed on the anterior abdominal wall. The peritoneum and fascia was closed with running a #1 looped PDS beginning at the inferior end of incision and proceeding towards the midline and then starting from the superior edge of the incision towards the midline and tying them together in the midline. Subcutaneous tissues were irrigated. Staples were placed in the skin. Sterile dressing was placed. The patient tolerated the procedure well. Sponge, lap, needle counts and instruments were correct x 2. Patient was extubated and sent to recovery room in stable condition.

PATH
Attention:  Malignant

A  Right ovary and fallopian tube, salpingo oophorectomy:
       Benign ovary.
       Benign fallopian tube with paratubal cyst.

B.  Right pelvic side wall/right obturator lymph node, biopsy:
       Poorly differentiated squamous cell carcinoma involving
fibroadipose tissue.
       No lymph node tissue is identified.  

C.  Right external lymph node, biopsy:
       Benign adipose tissue.  
       No lymph node tissue is identified.
Comments (1)
Posted By Melanie Witt on 04-08-2019, 19:01:33
I would go with 58957 and possibly 38770-59-RT. 38770 has a bilateral indicator of "1" which means, per the Medicare data base, " Reporting these bilateral-indicator-1 procedures with either LT or RT and 1 unit of service is appropriate only if the procedure is being performed unilaterally. If the procedure is performed bilaterally, modifier 50 should be appended to the procedure code with 1 unit of service." The problem here is that the path report says there was no lymph node tissue so I am not sure you can support 38770 on the right side even though he thought he was removing lymph nodes. And also the pelvic lymphadenectomy requires removal of the hypogastric, external iliac and obturator nodes and his description does not include all of these. I think you should go back and discuss this with him before billing.
Do you want to remove this attachment from this post?
Yes No
Do you want to add this specialty to your selected specialty list?
Yes No
To comment, please register for any of our webinars. Click here to register for our upcoming webinars.
Close
This comment will be permanently deleted. Do you still want to continue?
Yes No
Do you want to remove this comment from this discussion?
Yes No
Do you want to block this user from participating in this discussion?
Yes No
Do you want to allow this user to participate in this discussion?
Yes No
This post will not be available for further discussion/comments if deleted. Do you still want to continue?
Yes No