|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
|49321||Laparoscopy, surgical: with biopsy (single or multiple)||5424 |
|49322||with aspiration of cavity or cyst (e.g. Ovarian cyst) single or |
|49323||with drainage of lymphocele to peritoneal cavity||5421 |
|49329||Unlisted laparoscopy procedure, abdomen, peritoneum and |
|58550||Laparoscopy, surgical: with vaginal hysterectomy with or without |
removal of tube(s), with or without removal of ovary(s)
(laparoscopic assisted vaginal hysterectomy)
|58551||with removal of leiomyomata (single or multiple)||6829 |
|58559||with lysis of intrauterine adhesions (any method)||6821 |
|58560||with division or resection of intrauterine septum (any method)||6822 |
|58561||with removal of leiomyomata||6829 |
|58563||with endometrial ablation (any method)||6823|
|58578||Unlisted laparoscopy procedure, uterus||6999 |
|58579||Unlisted hysteroscopy procedure, uterus||6812|
|58660||Laparoscopy, surgical with lysis of adhesions (salpingolysis, |
ovariolysis) (separate procedure)
|58661||with removal of adnexal structures (partial or total oophorectomy |
|58662||with fulguration or excision of lesions of the ovary, pelvic viscera |
or peritoneal surface by any method
|58670||with fulguration of oviducts (with or without transection)||6629|
|58671||with occlusion of oviducts by device (e.g. band, clip or Falope |
|58672||with fimbrioplasty||6679 |
|58673||with salpingostomy (salpingoneostomy)||6602 |
|58679||Unlisted laparoscopy procedure, oviduct, ovary||6599 |
|47562||Laparoscopy, surgical; cholecystectomy||5123|
|47563||cholecystectomy with cholangiography||5123 |
|47564||cholecystectomy with exploration of common duct||5123 |
|47579||Unlisted laparoscopy procedure, biliary tract||5199 |
|49650||Laparoscopy, surgical: repair initial inguinal hernia||5300 |
|49651||repair recurrent inguinal hernia||5300 |
|49659||Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, |
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
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.
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.
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.
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.