Forum - Questions & Answers

Nov 24th, 2015 - Victoria001 1 

Ovarian cysts

Would someone be able to explain to me the difference between 49322 (lap with aspiration of cavity or cyst (eg ovarian cyst)) AND 58662 (Lap with fulguration or excision of lesions of the ovary, pelvic, viscera, or peritoneal surface by any method)?

What key words should I be looking for in the op note?


Nov 24th, 2015 - Jackfraust 69 

re: Ovarian cysts

The physician makes a 1.0-centimeter incision in the umbilicus through which the abdomen is inflated and a fiberoptic laparoscope is inserted. A second incision is made directly below the umbilicus, just above the pubic hairline, through which a trocar can be passed into the abdominal cavity to deliver instruments. The physician manipulates the tools to view the pelvic organs through the laparoscope. An additional incision may be needed for a second light source. Once the biopsy site is viewed through the laparoscope, a 5.0-centimeter incision is made just above the site. Through this incision, the physician uses an aspirating probe to aspirate a cavity or cyst or to collect fluid for culture. The instruments are removed and the incisions are sutured.

The physician performs a laparoscopic electrical cautery destruction of an ovarian, pelvic or peritoneal lesion with the assistance of a fiberoptic laparoscope. The physician may first insert an instrument through the vagina to grasp the cervix and manipulate the uterus during surgery. Next, the physician makes a small incision just below the umbilicus through which a fiberoptic laparoscope is inserted. A second incision is made on the left or right side of the abdomen with additional instruments being placed through these incisions into the abdomen or pelvis. The physician manipulates the tools so that the pelvic organs can be observed, manipulated and operated upon with the laparoscope. Once lesions are identified with the laparoscope, a third incision is typically made adjacent to the lesion through which an electric cautery tool, knife, or laser is inserted for lesion fulguration. The abdomen is deflated, the trocars removed and the incisions are closed with sutures.

Words to look for would be the aspiration, fulguration or excision. The difference is in the definition of the terms

Nov 24th, 2015 -

re: Ovarian cysts

per CPT® 49322 is an lap w/aspiraton, which mean removal by suction of fluid, tissue or gas. CPT® code 58622 is a lap/w fulguration, which fulgaration is to destroy w/electric currrent any lesions of the ovary, pelvic, etc.

CPT® also states that for laparascopic fulguration or excision of lesion of the ovary, pelvic viscera, or peritoneal surface to use 58622. This is stated right in the CPT® book under Laparoscopy starting with the code 49320.

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