SGO Issues September 5, 2019
Coding Corner: Ovarian cancer debulking
Housing, registration, call for abstracts now open for SGO Winter Meeting
September is Gynecologic Cancer Awareness Month
Did you get your SGO 2020 Practice Survey link?
SGO 2019 Allied Health Professionals Meeting: Early registration ends tomorrow
Focus on endometrial cancer for September Gynecologic Oncology
This month, Eileen M. Segreti, MD, member of the SGO Coding Task Force, describes five common scenarios involving ovarian cancer debulking and the method and rationale for CPT coding. Learn more about surgical coding during the Coding Bootcamp webinar on Sept. 18 at 6:30 p.m. CT.
How should you code for each of these tumor debulking scenarios?
- A 51-year-old woman with abdominal pain and elevated CA-125 presents to your office. CT shows a pelvic mass, omental cake and small volume ascites. You take the patient to the operating room for a debulking procedure. You find a loop of ileum adherent to a malignant ovarian tumor. You perform a radical dissection to complete a hysterectomy with bilateral salpingo-oophorectomy along with omentectomy, and small bowel resection with re-anastomosis.
a. Code 58953 for the TAH-BSO radical debulking and omentectomy
b. Code 44120-51 for the small bowel resection and single anastomosis
c. If you removed 2 separate pieces of bowel with 2 anastomoses, then +44121 would be an appropriate add-on code as well
- A 70-year-old woman presents with abdominal pain and anemia. CT shows a 15 cm right ovarian mass adherent to the cecum. She had a prior hysterectomy. You perform an exploratory laparotomy, BSO, omentectomy and ileocolic resection with re-anastomosis for a granulosa cell tumor of the right ovary with metastatic disease to the cecum.
a. Code 58950 for the BSO and omentectomy
b. Code 44140-51 for the partial colectomy
- A 40-year-old woman has an enlarged uterus, abnormal uterine bleeding and a family history of colon cancer. Endometrial biopsy shows grade 2 endometrial cancer. She has para-aortic and pelvic lymphadenopathy and an enlarged left ovary on CT. Findings at surgery reveal an enlarged uterus with left ovarian and recto-sigmoid involvement along with pelvic peritoneal disease. You perform a TAH-BSO, omentectomy, tumor debulking, limited para-aortic and pelvic lymphadenectomy, recto-sigmoid resection, coloproctostomy, low pelvic anastomosis, and mobilization splenic flexure. This leaves her with no gross disease.
a. Code 58954 for the TAH-BSO, omentectomy, lymph node resection and debulking
b. Code 44145-51 for the recto-sigmoid resection with low pelvic anastomosis
c. Add-on Code + 44139 mobilization of the splenic flexure
- An 86-year-old woman with ascites, carcinomatosis and pleural effusions positive for serous carcinoma underwent neoadjuvant chemotherapy with an excellent response. Patient and family are requesting minimally invasive surgery. You perform laparoscopy with hysterectomy BSO, omentectomy and debulking of all gross residual disease.
a. Code 58575 laparoscopy, surgical with total hysterectomy, with or without salpingo-oophorectomy, unilateral or bilateral, with resection of malignancy (tumor debulking) with omentectomy.
- A 55-year-old with history of endometriosis has a 12 cm ovarian mass and elevated CA125. You perform an exploratory laparotomy, TAH-BSO, omentectomy, limited para-aortic lymphadenectomy. Frozen section reveals endometrioid adenocarcinoma of the ovary. You perform an appendectomy for suspected endometriosis of the appendix.
a. Code 58951 initial resection of ovarian, tubal or peritoneal cancer with BSO, omentectomy, TAH and limited pelvic and para-aortic lymphadenectomy-
b. Add-on Code +44955 for the indicated appendectomy
Dr. Segreti is Vice Chair, Department of Obstetrics and Gynecology, Allegheny Health Network, Pittsburgh, PA.
Housing and registration are now open for the SGO 25th Annual Winter Meeting at the Westin Snowmass Resort, near Aspen, CO. Young investigators are invited to submit research for consideration for presentation at the meeting. The deadline to submit abstracts is Monday, Oct. 14, 2019, at 11:59 p.m. Central Time. Please note, if you are submitting an abstract for both the SGO 25th Winter Meeting and SGO 2020 Annual Meeting, you may only present at one of these meetings. Accepting an invitation to present an abstract at one meeting will eliminate your eligibility to present the same abstract at the other.
“I wish I knew that bleeding after menopause could possibly be cancer.” – Kim S.
Take action this month to spread awareness and education in your community. Visit the Foundation for Women’s Cancer website or download the GCAM toolkit for resources you and your institution can use—including sample social media posts, educational posters listing signs and symptoms of gynecologic cancers, and information that can easily be added to your institution’s website, so patients and their loved ones know where to go to learn more about gynecologic cancers. If your institution or local community center is hosting an event during GCAM, please send the details to firstname.lastname@example.org and FWC can help promote it on social media.
If you have not received your individualized survey link for the SGO 2020 Practice Survey, please contact Jessica Oldham or Traci Schwendner. Eligible SGO members who complete the survey will receive a free electronic copy of the results—a value of $60–and be entered to win a free registration to the SGO 2020 Annual Meeting on Women’s Cancer, March 28-31 in Toronto, Canada.
The SGO 2019 Allied Health Professionals Meeting, Oct. 18-20 in Rosemont, IL, brings together physician assistants, nurse practitioners and registered nurses who treat patients with gynecologic cancers. Early registration ends tomorrow, Sept. 6, so make sure you or your staff sign up now to save on registration.
- Review of chemotherapy regimens used for treatment of gynecologic malignancies
- Strategies for prevention and management of chemotherapy-related adverse events
- Consolidation versus maintenance chemotherapy for the gynecologic oncology patient
- PARP inhibitors
- Genetics update
- Use of anticoagulation with gynecologic oncology patients—prophylactic use versus acute and chronic treatment
- Immunotherapy side effects and management
- Addressing the barriers for pain management in gynecologic cancer patients in the era of the opioid crisis
- Active Hexose Correlated Compound (AHCC) for clearance of human papillomavirus (HPV) infections—phase II results and ongoing study updates
- Hormone replacement therapy
- Addressing compassion fatigue and burnout
Hotel rooms are available at a discounted rate for the Hilton Rosemont Chicago O’Hare through Sept. 26. Educational sessions will begin Friday, Oct. 18, with a half-day starting in the afternoon, a full day Saturday and a half-day on Sunday ending in the afternoon.
For more information, contact SGO’s education team at email@example.com.
Editorial: Precision medicine in endometrial cancer Jessica N. McAlpine, C. Blake Gilks
Research Report (Editor’s Choice): Comprehensive genomic profiling of recurrent endometrial cancer: Implications for selection of systemic therapy Emily N. Prendergast, Laura L. Holman, Annie Y. Liu, Tiffany S. Lai, Maira P. Campos, Jacquline N. Fahey, Xiaoyan Wang, Nabilah Abdelaal, Jian Yu Rao, Julia A. Elvin, Kathleen M. Moore, Gottfried E. Konecny, Joshua G. Cohen