Common Surgical Procedures Gyn/Oncology

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1 Malignancy Description Codes wrvu Comments Cervical Typical Open Cone biopsy Leep conization Colposcopy/Leep TAH +/- BSO Radical hysterectomy +/- BSO (Total, bilateral) Includes excision of parametria and ureteral dissection. Can be used for TAH PLND Radical trachelectomy /-BSO Cervical Less Common Open Radical vaginal hyst (Schauta) Includes excision of parametria and ureteral dissection Modifier 52 fertility sparing +/- nodes Radical vaginectomy Partial removal wall Includes removal of paravaginal tissue Partial Vaginectomy use Radical vaginectomy Includes removal of paravaginal tissue Partial removal wall Radical vaginectomy Complete removal wall Includes removal of paravaginal tissue Complete vaginectomy Radical vaginectomy Includes removal of paravaginal tissue Complete removal wall Use modifier 50 for bilateral procedure External iliac Hypogastric/Obturator Cervical Laparoscopic Radical hysterectomy /- BSO

2 Malignancy Description Codes wrvu Comments Endometrial Open TAH +/- BSO TAH +/- BSO P&P sampling Radical hysterectomy +/- BSO (Total, bilateral) Debulking Debulking Limited para-aortic lymphadenectomy P&P nodes Includes excision of parametria and ureteral dissection. Can be used for TAH PLND Code indicates used for malignancy only Increase fee to reflect use of modifier 22 Endometrial Laparoscopic LAVH <250gms LAVH BSO LAVH >250gms LAVH BSO TLH <250gms TLH BSO TLH >250gms TLH BSO Endometrial Laparoscopic Nodes Retroperitoneal sampling Single or multiple nodes Single or multiple nodes 2

3 Malignancy Description Codes wrvu Comments Ovarian/ Open Peritoneal Oophorectomy P&P node sampling Peritoneal biopsies/washings +/- salpingectomy Partial or total oophorectomy, unilateral or bilateral Specific for ovarian, tubal, or primary peritoneal malignancy +/- omentectomy BSO Initial resection of ovarian, tubal, or primary peritoneal malignancy Ovarian/ Peritoneal Limited para-aortic lymphadenectomy BSO Debulking (radical dissection), Debulking (radical dissection) Debulking (radical dissection) Limited para-aortic lymphadenectomy Debulking +/- omentectomy Debulking +/- omentectomy Limited para-aortic lymphadenectomy Staging (second look) +/- omentectomy Biopsy abd/pelvic Pelvic and limited para-aortic lymphadenectomy Laparoscopic Second look with biopsy With nodes Staging Initial resection of ovarian, tubal, or primary peritoneal malignancy Initial resection of ovarian, tubal, or primary peritoneal malignancy Radical excision/destruction intraabdominal or retroperitoneal tumors All sites All sites All sites Recurrent gyn resection Recurrent gyn resection Specific for ovarian, tubal, or primary peritoneal malignancy No codes for debulking: unlisted 22 modifier as appropriate 3

4 Vaginal Open Vaginectomy, partial Vaginectomy, partial Removal of paravaginal tissue (radical) Vaginectomy, partial Removal of paravaginal tissue (radical) Bilateral total pelvic lymphadenectomy Para-aortic lymph node sampling Vaginectomy, complete Vaginectomy, complete Removal of paravaginal tissue (radical) Vaginectomy, complete Removal of paravaginal tissue (radical) Bilateral total pelvic lymphadenectomy Para-aortic lymph node sampling Biopsy of vaginal mucosa, simple Biopsy of vaginal mucosa, extensive Requires sutures Includes cysts Destruction of lesion(s), simple Destruction of lesion(s), extensive

5 Vulvar Simple: removal of skin and superficial subcutaneous tissue Radical: removal of skin and deep subcutaneous tissue Partial: Removal of <80% vulvar area Complete: Removal of >80% vulvar area Vulvar Open Vulvectomy, simple, partial Vulvectomy, simple, complete Vulvectomy, radical, partial Vulvectomy, radical, partial Unilateral inguinofemoral lymphadenectomy Vulvectomy, radical, partial Bilateral inguinofemoral lymphadenectomy Vulvectomy, radical, complete Vulvectomy, radical, complete Unilateral inguinofemoral lymphadenectomy Vulvectomy, radical, complete Bilateral inguinofemoral lymphadenectomy Vulvectomy, radical, complete Inguinofemoral lymphadenectomy Iliac lymphadenectomy Biopsy vulva or perineum; 1 lesion Biopsy of each additional lesion vulva or Add on code. Use with perineum Excision benign lesion of genitalia Varies by code Based on excised diameter. Use if skin not excised. Excision malignant lesion of genitalia Intermediate repair code genitalia Varies by code Varies by code Based on excised diameter. Use if skin not excised. Use in conjunction with and if layered closure required 5

6 Bowel Open Procedures Partial with anastomosis Colectomy Skin level cecostomy or colostomy End colostomy and closure of distal segment (Hartmann type procedure) Resection, with colostomy or ileostomy Creation of mucofistula Coloproctostomy (low pelvic anastomosis) Coloproctostomy (low pelvic anastomosis) Colostomy Abdominal and Transanal approach Mobilization (take-down) of splenic Add on code. Use with flexure Colectomy, partial Removal of terminal ileum with ileocolostomy Total Colectomy, total Colectomy Ileostomy or ileoproctostomy Continent ileostomy Proctectomy Ileostomy Proctectomy Continent ileostomy Proctectomy Includes loop ileostomy, and rectal mucosectomy, when performed Ileoanal anastomosis, Proctectomy Includes loop ileostomy, and rectal mucosectomy, when performed Ileoanal anastomosis Creation of ileal reservoir (S or J) Enterectomy Small bowel resection Each additional resection and Add-on code. Use with anastomosis Small bowel resection Enterostomy

7 Bowel Laparoscopic Procedures Laparoscopic enterectomy Single resection of small intestine Anastomosis Each additional small intestine resection Add-on code. Use with and anastomosis Laparoscopic partial colectomy Anastomosis Laparoscopic partial colectomy Removal of terminal ileum Ileocolostomy Laparoscopic partial colectomy End colostomy and closure of distal segment (Hartmann type procedure) Laparoscopic partial colectomy Coloproctostomy (low pelvic anastomosis) Laparoscopic partial colectomy Coloproctostomy (low pelvic anastomosis) Colostomy Laparoscopy mobilization (take-down) of splenic flexure Add-on code. Use with

8 Other Open Procedures Exploratory laparotomy Includes biopsies if performed Excision or destruction, open, intra-abdominal tumors, cysts or endometriomas, 1 or more peritoneal, mesenteric, or retroperitoneal primary or secondary tumors; largest tumor 5 cm diameter Codes appropriate when primary organs have been removed. If ovarian tumor, use appropriate ovarian tumor or BSO code. or less Largest tumor cm diameter Largest tumor greater than 10.0 cm diameter Appendectomy; For indicated purpose at time of major procedure Add-on code. Report in addition to primary surgical procedure Enterolysis Designated as (Separate procedure). Generally not reported in addition to other surgical codes. If enterolysis is extensive, may report with 59 modifier Other Procedures Ureterolysis, with or without repositioning of ureter for retroperitoneal fibrosis Laparoscopy Must have diagnosis of retroperitoneal fibrosis to report. Typically, ureterolysis is included in major surgical procedure. Diagnostic laparoscopy Laparoscopy with biopsy Use for ovarian biopsy Laparoscopy with aspiration of cavity or cyst Use for aspiration of ovarian cyst (single or multiple) Laparoscopic appendectomy There is not an add-on code for laparoscopic appendectomy Laparoscopic enterolysis Designated as (Separate procedure). Generally not reported in addition to other surgical codes. If enterolysis is extensive, may report with 59 modifier 8