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Coding TABBSO, Omenctectomy and right pelvic lymphadenectomy

Posted By Mary Peabody on 04-13-2020, 14:30:34 in Ob-Gyn

Hello Melanie

A TAH/BSO Omentectomy and right pelvic lymphadencectomy was performed for ovarian cancer. Would you report this with 58150 38500-51 or 58951-52 (modifier 52 since no para-aortic lymphadenctomy was not performed.

POSTOPERATIVE DIAGNOSIS: High-grade malignancy of the right ovary,
final pathology pending

OPERATION: Exploratory laparotomy, total abdominal hysterectomy,
bilateral salpingo-oophorectomy, right pelvic lymphadenectomy,
omentectomy, cystoscopy, bladder repair, and control of pelvic hemorrhage

FINAL PATHOLOGIC DIAGNOSIS

A. Right adnexa, salpingo-oophorectomy:
- Ovary: Adenocarcinoma; see comment.
- Fallopian tube: No significant pathologic abnormality.

B. Uterus with left adnexa, total hysterectomy, salpingo-oophorectomy:
- Cervix: No significant pathologic abnormality.
- Endometrium: Endometrial polyps.
- Myometrium: No significant pathologic abnormality.
- Serosa: No significant pathologic abnormality.
- Fallopian tube: No significant pathologic abnormality.
- Ovary: No significant pathologic abnormality.

C. Right pelvic lymph nodes, dissection:
1. No tumor (0/4).
2. Reactive lymphoid hyperplasia.

D. Right common iliac lymph nodes, dissection:
1. No tumor (0/3).
2. Reactive lymphoid hyperplasia.

E. Omentum, 1 with nodule, omentectomy:
1. Surface adhesions.
2. Calcified organizing fat necrosis.

F. Omentum, #2, omentectomy: Surface adhesions.

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Hello Melanie

A TAH/BSO Omentectomy and right pelvic lymphadencectomy was performed for ovarian cancer. Would you report this with 58150 38500-51 or  58951-52 (modifier 52 since no para-aortic lymphadenctomy was not performed.

POSTOPERATIVE DIAGNOSIS:  High-grade malignancy of the right ovary, 
final pathology pending
 
OPERATION:   Exploratory laparotomy, total abdominal hysterectomy, 
bilateral salpingo-oophorectomy, right pelvic lymphadenectomy, 
omentectomy, cystoscopy, bladder repair, and control of pelvic hemorrhage

FINAL PATHOLOGIC DIAGNOSIS
 
A. Right adnexa, salpingo-oophorectomy: 
- Ovary: Adenocarcinoma; see comment.
- Fallopian tube: No significant pathologic abnormality. 
 
B. Uterus with left adnexa, total hysterectomy, salpingo-oophorectomy:
- Cervix: No significant pathologic abnormality. 
- Endometrium: Endometrial polyps.
- Myometrium: No significant pathologic abnormality. 
- Serosa: No significant pathologic abnormality. 
- Fallopian tube: No significant pathologic abnormality. 
- Ovary: No significant pathologic abnormality. 
 
C. Right pelvic lymph nodes, dissection: 
1. No tumor (0/4).
2. Reactive lymphoid hyperplasia.
 
D. Right common iliac lymph nodes, dissection: 
1. No tumor (0/3).
2. Reactive lymphoid hyperplasia.
 
E. Omentum, 1 with nodule, omentectomy:  
1. Surface adhesions.   
2. Calcified organizing fat necrosis.
 
F. Omentum, #2, omentectomy:  Surface adhesions.

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Posted By Melanie Witt on 04-13-2020, 16:47:54

58951-52. The code represents not just the limited para-aortic lymphadenectomy, but according to the clinical vignette submitted to CPT, also a bilateral pelvic lymphadenectomy - so your surgeon did only one side and you need to make that clear to the payer when explaining the work not performed. Also, 38500 would not represent the work involved with a total right pelvic lyphadenectomy (physician work is only 3.79 RVS as opposed to a complete bilateral lymphadenectomy (38770) with 14.06 physician work RVUs).