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