LAPAROSCOPIC SURGERY CPT CODES 49320, 58661

LAPAROSCOPY ; LAPAROSCOPIC SURGERY Procedures and Related CPT and ICD-9
Procedure Codes



CPT Code CPT Description ICD -9 Procedure



49320 Laparoscopy, abdomen, peritoneum and omentum, diagnostic,
with or without collection of specimen(s) by brushing or washing
(separate procedure)
5421



49321 Laparoscopy, surgical: with biopsy (single or multiple) 5424
5421



49322 with aspiration of cavity or cyst (e.g. Ovarian cyst) single or
multiple
5424
6591
5421



49323 with drainage of lymphocele to peritoneal cavity 5421
540



49329 Unlisted laparoscopy procedure, abdomen, peritoneum and
omentum
5421
5499



58550 Laparoscopy, surgical: with vaginal hysterectomy with or without
removal of tube(s), with or without removal of ovary(s)
(laparoscopic assisted vaginal hysterectomy)
6851



58551 with removal of leiomyomata (single or multiple) 6829
5421



58559 with lysis of intrauterine adhesions (any method) 6821
6812



58560 with division or resection of intrauterine septum (any method) 6822
6812



58561 with removal of leiomyomata 6829
6812



58563 with endometrial ablation (any method) 6823



58578 Unlisted laparoscopy procedure, uterus 6999
5421



58579 Unlisted hysteroscopy procedure, uterus 6812



58660 Laparoscopy, surgical with lysis of adhesions (salpingolysis,
ovariolysis) (separate procedure)
6581



58661 with removal of adnexal structures (partial or total oophorectomy
and/or salpingectomy)
6541



58662 with fulguration or excision of lesions of the ovary, pelvic viscera
or peritoneal surface by any method
6525



58670 with fulguration of oviducts (with or without transection) 6629



58671 with occlusion of oviducts by device (e.g. band, clip or Falope
ring)
6629



58672 with fimbrioplasty 6679
5421



58673 with salpingostomy (salpingoneostomy) 6602
5421



58679 Unlisted laparoscopy procedure, oviduct, ovary 6599
5421



47562 Laparoscopy, surgical; cholecystectomy 5123



47563 cholecystectomy with cholangiography 5123
8753



47564 cholecystectomy with exploration of common duct 5123
5151
5183



47570 cholecysto-enterostomy 5132
5421



47579 Unlisted laparoscopy procedure, biliary tract 5199
5421



49650 Laparoscopy, surgical: repair initial inguinal hernia 5300
5421



49651 repair recurrent inguinal hernia 5300
5421



49659 Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy,
herniotomy
539
5421

Billing and Coding Guidelines



Incidental includes procedures that can be performed along with the  primary procedure, but are not essential to complete the procedure. They  do not typically have a significant impact on the work and time of the  primary procedure. Incidental procedures are not separately reimbursable  when performed with the primary procedure.


 For example: CPT code 58660, Lysis of adhesions, is not to be reported  separately when done in conjunction with CPT code 58661, Laparoscopy,  surgical; with removal of adnexal structures (partial or total oophorectomy  and/or salpingectomy)


HCPCS Code Code   Description  In-Office    In-Facility     Hospital Outpatient Payment     ASC Payment 

58660 - Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate procedure) $ 680

58661  Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectom]  -  $616   $3,060   $1,284


Edit:

58740 (Lysis of adhesions (salpingolysis, ovariolysis with Laparoscopy, surgical) bundles with 58661 (Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy)


CODE RULE CODE

58740 Mutually Exclusive 58661

Rationale for Edit:

Anthem Central Region bundles 58740 with 58661 based on the National correct coding Initiative Edits, code 58740 is listed as a component code to code 58661. Based on American College of Obstetricians and Gynecologists, it states "Services that cannot be reported with 58661 under any circumstances- Lysis of adhesions (44005, 44180, 58660 and 58740)”. Therefore, if code 58740 is submitted with code 58661  only 58661 will reimburse.

Rationale

Anthem Central Region bundles 49322 as incidental with 58662, bundles 49332-LT as incidental with 58662-LT and bundles 49322-RT as incidental with 58662-RT Based on American College of Obstetricians and Gynecologists, it states on code 58662 and under services included intraoperative services: “Destruction or excision of lesions, any method”. Therefore, if 49322 is submitted with 58662—only 58662 reimburses, if 49322-LT is submitted with 58662-LT—only 58662-LT reimburses and if 49322-RT is submitted with 58662-RT only 58662-RT reimburses.

If on compliant/appeal. Documentation shows that 49322 was performed on one ovary and 58332 was performed on the opposite ovary, both services reimburse separately.

Laparoscopic oophorectomy

Q. The doctor performed a video laparoscopy, left salpingo-oophorectomy, right ovarian cystectomy, and peritoneal biopsy. What CPT codes and modifiers would you use?

A. The correct codes are 58661 and 49321-51. Code 58661 describes partial or total oophorectomy and/or salpingectomy. If you look up ovarian cystectomy in the index of CPT, you are referred to code 58661 for that portion of the procedure also. The code cannot be reported with the bilateral modifier, which means that although procedures were done on the right and left sides, this code includes both procedures.

Report 49321 -- laparoscopy, surgical; with biopsy -- for the peritoneal biopsy and, since it is the lesser service, add the -51 modifier. These codes are not bundled under CCI, therefore, the -51 modifier is used instead of the -59.


Modifier 22: Procedure  with Modifier 22

This rule will pend the claim for additional review for increase of allowance when the procedure code is billed with modifier 22 to identify unusual procedural services AND the claim is submitted with medical records.

Procedure code 58661 is billed with modifier 22 and medical records - the claim will be pended for medical review for possible additional


Billing Guidelines for CPT CODE 49320

49320 - Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)

Surgical laparoscopy always includes diagnostic laparoscopy. To report a diagnostic laparoscopy (peritoneoscopy) (separate procedure), use 49320.

Surgical laparoscopy always includes diagnostic laparoscopy. To report a diagnostic laparoscopy (peritoneoscopy) (separate procedure), use 49320. To report a diagnostic hysteroscopy (separate procedure), use 58555.

Female Genital System

1. When a pelvic examination is performed in conjunction with a gynecologic procedure, either as a necessary part of the procedure or as a confirmatory examination, the pelvic examination is not separately reportable. A diagnostic pelvic examination may be performed for the purpose of deciding toperform a procedure. This examination is included in the evaluation and management service at the time the decision to perform the procedure is made.

2. All surgical laparoscopic, hysteroscopic or peritoneoscopic procedures include diagnostic procedures. Therefore, CPT code 49320 is included in CPT codes 38120, 38570- 38572, 43280, 43651-43653, 44180-44227, 44970, 47562-47570, 49321-49323, 49650-49651, 54690-54692, 55550, 58545-58554, 58660- 58673, and 60650. CPT code 58555 is included in CPT codes 58558- 58565.

CPT code 49320 states: “Surgical laparoscopy always includes diagnostic laparoscopy. . .” Therefore the surgical laparoscopic procedure described by the column one HCPCS code G0342 (Laparoscopy for islet cell transplant, includes portal vein catheterization and infusion) includes the diagnostic laparoscopic procedure described by the column two CPT code 49320 (Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)). Based on the CPT Manual instruction CPT code 49320 is bundled into HCPCS code G0342.

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