Coding Corner: Ovarian Cancer Debulking | Eileen M. Segreti, MD

Eileen M. Segreti, MD

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?

1. 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
2. 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
3. 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
4. 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.
5. 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.