The SGO Coding Committee promotes new and revised codes to help optimize billing efficiency and reimbursement for gynecologic oncologists. These efforts ensure that the use of standard terms and descriptors to document procedures in the medical record reflect current medical practice. The Committee also works with the American Congress of Obstetricians and Gynecologists to provide recommendations and support for proposals through the American Medical Association to ultimately receive approval by the Centers for Medicare & Medicaid Services. In addition, the Committee interfaces with national and government agencies on practice management and reimbursement issues.

Laparoscopic ovarian cancer staging and debulking | Kevin Holcomb, MD, FACOG

Kevin Holcomb, MD, FACOG

If you are a gynecologic oncologist with a clinical interest in minimally invasive surgery, you have likely extended your laparoscopic skills to the management of women with ovarian cancer. If so, you have probably noticed that there is currently no CPT code for laparoscopic omentectomy and no way to bill laparoscopic comprehensive staging nor debulking procedures.

Presently your billing options are to use an unlisted CPT code (49329: unlisted laparoscopic procedure of the abdomen, peritoneum, omentum) or the CPT code for laparoscopy with biopsy (49321) appended with a 22 modifier to represent the additional work. Neither of these options adequately represent the work and time involved and may result in no (i.e., 49329) or inadequate (49321-22) reimbursement. 

Fortunately, the SGO Coding and Reimbursement Taskforce took notice of this issue and petitioned CMS for novel CPT codes for both ovarian cancer staging and debulking. Both have been approved and have been available since Jan. 1, 2018. Below are the descriptions and some important aspects of both codes.

CPT code 38573 (Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling (biopsy), single or multiple, peritoneal washings, single or multiple peritoneal biopsies, omentectomy, and diaphragmatic washings with or without biopsies.) 

  • 10 day global period
  • Never billed in conjunction with 38570-38572, 49255, 49320-49322, 58570-58572
  • Inpatient or outpatient
  • Can be used for ovarian, uterine, peritoneal, cervical, or fallopian tube cancer
  • 20 work RVU

CPT code 58575 (Laparoscopy, surgical, total hysterectomy; with or without salpingo-oophorectomy, unilateral or bilateral, with resection of malignancy (tumor debulking), with omentectomy) should be used to bill a laparoscopic ovarian cancer debulking. 

  • 90 day global period
  • Never billed in conjunction with 49255, 49320-49321, 58570-58573, 58661
  • Inpatient or outpatient
  • Can be used for ovarian, uterine, peritoneal, cervical, or fallopian tube cancer
  • 32.6 work RVU

These two novel CPT codes should simplify the coding and billing of minimally invasive procedures that are increasingly being performed for our ovarian cancer patients and ensure adequate reimbursement for the SGO membership. 

Kevin Holcomb, MD, FACOG, is a gynecologic oncologist at the New York Presbyterian Hospital-Weill Cornell Medical College in New York City.

SGO Coding Q & A

Ask a coding question.
Download archived coding questions and answers.

SGO members and professional coders may seek coding advice and recommendations by submitting an email to Answers to incoming questions are provided by the members of the SGO Coding and Reimbursement Taskforce and represent their opinion based upon the current and usual practices in the field. Every effort is made to ensure the accuracy of the information provided. However, the information neither replaces information in Medicare regulations, the CPT-4 code book, or the ICD-9 CM code book; nor does it constitute legal advice. Responses to questions are intended only as a guide and are not a substitute for specific accounting or legal opinions. SGO expressly disclaims all responsibility and liability arising from use of, or reliance upon this information as a reference source, and assumes no responsibility or liability for any claims that may result directly or indirectly from use of this information, including, but not limited to, claims of Medicare or insurance fraud.

Coding Tools

These tools are provided as a resource only and are not intended to replace the information in CPT or specific payer guidelines or requirements.

Common Surgical Procedures

Medicare Global Surgery Modifiers

The Medicare Global Surgery Modifiers document lists commonly reported modifiers along with information about proper usage and documentation.

Patient Assessment Forms

SGO ConnectTM Ed

SGO offers a variety of online learning opportunities about coding and compliance issues through SGO Connect Ed, including the four-part 2012 coding webinar series.