Common Surgical Procedures Gyn/Oncology

1 Common Surgical Procedures Gyn/Oncology 1 Malignancy Description Codes wRVU Comments Cervical Typical Open Cone biopsy 57520 Leep conization 57522 Colposcopy/Leep 57461 TAH +/- BSO 58150 Radical hysterectomy +/- BSO Pelvic lymphadenectomy (Total, bilateral) Para-aortic sampling 58210 Includes excision of parametria and ureteral dissection. Can be used for TAH PLND Radical trachelectomy +/-BSO Pelvic lymphadenectomy (Total bilateral) Para-aortic sampling 57531 Cervical Less Common Open Radical vaginal hyst (Schauta) 58285 Includes excision of parametria and ureteral dissection Modifier 52 fertility sparing +/- nodes Radical vaginectomy Partial removal wall 57107 Includes removal of paravaginal tissue Partial Vaginectomy use 57106 Radical vaginectomy Partial removal wall Pelvic lymphadenectomy (Total bilateral) Para-aortic sampling 57109 Includes removal of paravaginal tissue Radical vaginectomy Complete removal wall 57111 Includes removal of paravaginal tissue Complete vaginectomy 57110 Radical vaginectomy Complete removal wall Pelvic lymphadenectomy (Total bilateral)

2 Para-aortic sampling 57112 Includes removal of paravaginal tissue Pelvic lymphadenectomy External iliac Hypogastric/Obturator 38770 Use modifier 50 for bilateral procedure Cervical Laparoscopic Radical hysterectomy +/- BSO Pelvic lymphadenectomy (Total bilateral) Para-aortic sampling 58548 Pelvic lymphadenectomy (Total bilateral) 38571 Pelvic lymphadenectomy (Total bilateral) Para-aortic sampling 38572 Common Surgical Procedures Gyn/Oncology 2 Malignancy Description Codes wRVU Comments Endometrial Open TAH +/- BSO 58150 TAH +/- BSO P&P sampling 58200 Radical hysterectomy +/- BSO Pelvic lymphadenectomy (Total, bilateral) Para-aortic sampling 58210 Includes excision of parametria and ureteral dissection. Can be used for TAH PLND TAH/BSO Omentectomy Debulking 58953 TAH/BSO Omentectomy Debulking Pelvic lymphadenectomy Limited para-aortic lymphadenectomy 58954 TAH/BSO Omentectomy 58956 Code indicates used for malignancy only TAH/BSO P&P nodes Omentectomy 58210-22 Increase fee to reflect use of modifier 22 Endometrial Laparoscopic LAVH <250gms 58550 LAVH BSO 58552 LAVH >250gms 58553 LAVH BSO 58554 TLH <250gms 58570 TLH BSO 58571 TLH >250gms 58572 TLH BSO 58573 Endometrial Laparoscopic Nodes Retroperitoneal sampling 38570 Single or multiple nodes Pelvic lymphadenectomy (Total bilateral) 38571 Pelvic lymphadenectomy (Total bilateral)

3 Para-aortic sampling 38572 Single or multiple nodes Common Surgical Procedures Gyn/Oncology 3 Malignancy Description Codes wRVU Comments Ovarian/ Peritoneal Open Oophorectomy P&P node sampling Peritoneal biopsies/washings +/- salpingectomy +/- omentectomy 58943 Partial or total oophorectomy, unilateral or bilateral Specific for ovarian, tubal, or primary peritoneal malignancy BSO Omentectomy 58950 Initial resection of ovarian, tubal, or primary peritoneal malignancy TAH/BSO Omentectomy Pelvic lymphadenectomy Limited para-aortic lymphadenectomy 58951 Initial resection of ovarian, tubal, or primary peritoneal malignancy BSO Omentectomy Debulking (radical dissection) 58952 Initial resection of ovarian, tubal, or primary peritoneal malignancy Radical excision/destruction intra-abdominal or retroperitoneal tumors TAH/BSO, Omentectomy Debulking (radical dissection) 58953 All sites TAH/BSO Omentectomy Debulking (radical dissection) Pelvic lymphadenectomy Limited para-aortic lymphadenectomy 58954 All sites TAH/BSO Omentectomy 58956 All sites Debulking +/- omentectomy 58957 Recurrent gyn resection Debulking +/- omentectomy Pelvic lymphadenectomy Limited para-aortic lymphadenectomy 58958 Recurrent gyn resection Staging (second look) +/- omentectomy Biopsy abd/pelvic Pelvic and limited para-aortic lymphadenectomy 58960 Specific for ovarian, tubal, or primary peritoneal malignancy Ovarian/ Peritoneal Laparoscopic Second look with biopsy With nodes 49321 38572 No codes for debulking.

4 Unlisted Staging 49320 38572 22 modifier as appropriate Common Surgical Procedures Gyn/Oncology 4 Malignancy Description Code wRVU Comments Vaginal Open Vaginectomy, partial 57106 Vaginectomy, partial Removal of paravaginal tissue (radical) 57107 Vaginectomy, partial Removal of paravaginal tissue (radical) Bilateral total pelvic lymphadenectomy Para-aortic lymph node sampling 57109 Vaginectomy, complete 57110 Vaginectomy, complete Removal of paravaginal tissue (radical) 57111 Vaginectomy, complete Removal of paravaginal tissue (radical) Bilateral total pelvic lymphadenectomy Para-aortic lymph node sampling 57112 Biopsy of vaginal mucosa, simple 57100 Biopsy of vaginal mucosa, extensive 57105 Requires sutures Includes cysts Destruction of lesion(s), simple 57061 Destruction of lesion(s), extensive 57065 Common Surgical Procedures Gyn/Oncology 5 Malignancy Description Code wRVU Comments Vulvar Simple: removal of skin and superficial subcutaneous tissue Radical: removal of skin and deep subcutaneous tissue Partial: Removal of <80% vulvar area Complete.

5 Removal of >80% vulvar area Vulvar Open Vulvectomy, simple, partial 56620 Vulvectomy, simple, complete 56625 Vulvectomy, radical, partial 56630 Vulvectomy, radical, partial Unilateral inguinofemoral lymphadenectomy 56631 Vulvectomy, radical, partial Bilateral inguinofemoral lymphadenectomy 56632 Vulvectomy, radical, complete 56633 Vulvectomy, radical, complete Unilateral inguinofemoral lymphadenectomy 56634 Vulvectomy, radical, complete Bilateral inguinofemoral lymphadenectomy 56637 Vulvectomy, radical, complete Inguinofemoral lymphadenectomy Iliac lymphadenectomy Pelvic lymphadenectomy 56640 Biopsy vulva or perineum; 1 lesion 56605 Biopsy of each additional lesion vulva or perineum +56606 Add on code. Use with 56605 Excision benign lesion of genitalia 11420-11426 Varies by code Based on excised diameter. Use if skin not excised. Excision malignant lesion of genitalia 11620-11626 Varies by code Based on excised diameter.

6 Use if skin not excised. Intermediate repair code genitalia 12041-12047 Varies by code Use in conjunction with 11420-11426 and 11620-11626 if layered closure required Common Surgical Procedures Gyn/Oncology 6 Malignancy Description Code wRVU Comments Bowel Procedures Open Partial Colectomy Partial colectomy with anastomosis 44140 Partial colectomy Skin level cecostomy or colostomy 44141 Partial colectomy End colostomy and closure of distal segment (Hartmann type procedure) 44143 Partial colectomy Resection, with colostomy or ileostomy Creation of mucofistula 44144 Partial colectomy Coloproctostomy (low pelvic anastomosis) 44145 Partial colectomy Coloproctostomy (low pelvic anastomosis) Colostomy 44146 Partial colectomy Abdominal and Transanal approach 44147 Mobilization (take-down) of splenic flexure +44139 Add on code. Use with 44140-44147 Colectomy, partial Removal of terminal ileum with ileocolostomy 44160 Total Colectomy Colectomy, total Ileostomy or ileoproctostomy 44150 Total colectomy Continent ileostomy 44151 Total colectomy Proctectomy Ileostomy 44155 Total colectomy Proctectomy Continent ileostomy 44156 Total colectomy Proctectomy Ileoanal anastomosis, 44157 Includes loop ileostomy, and rectal mucosectomy, when performed Total colectomy Proctectomy Ileoanal anastomosis Creation of ileal reservoir (S or J) 44158 Includes loop ileostomy, and rectal mucosectomy, when performed Enterectomy Small bowel resection 44120 Each additional resection and anastomosis +44121 Add-on code.

7 Use with 44120 Small bowel resection Enterostomy 44125 Common Surgical Procedures Gyn/Oncology 7 Malignancy Description Code wRVU Comments Bowel Procedures Laparoscopic Laparoscopic enterectomy Single resection of small intestine Anastomosis 44202 Each additional small intestine resection and anastomosis +44203 Add-on code. Use with 44202 Laparoscopic partial colectomy Anastomosis 44204 Laparoscopic partial colectomy Removal of terminal ileum Ileocolostomy 44205 Laparoscopic partial colectomy End colostomy and closure of distal segment (Hartmann type procedure) 44206 Laparoscopic partial colectomy Coloproctostomy (low pelvic anastomosis) 44207 Laparoscopic partial colectomy Coloproctostomy (low pelvic anastomosis) Colostomy 44208 Laparoscopy mobilization (take-down) of splenic flexure +44213 Add-on code. Use with 44204-44208 Common Surgical Procedures Gyn/Oncology 8 Malignancy Description Code wRVU Comments Other Procedures Open Exploratory laparotomy 49000 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 or less 49203 Codes appropriate when primary organs have been removed.

8 If ovarian tumor, use appropriate ovarian tumor or BSO code. Largest tumor cm diameter 49204 Largest tumor greater than cm diameter 49205 Appendectomy; 44950 For indicated purpose at time of major procedure +44955 Add-on code. Report in addition to primary Surgical procedure Enterolysis 44005 Designated as (Separate procedure). Generally not reported in addition to other Surgical codes. If enterolysis is extensive, may report with 59 modifier Ureterolysis, with or without repositioning of ureter for retroperitoneal fibrosis 50715 Must have diagnosis of retroperitoneal fibrosis to report. Typically, ureterolysis is included in major Surgical procedure. Other Procedures Laparoscopy Diagnostic laparoscopy 49320 Laparoscopy with biopsy 49321 Use for ovarian biopsy Laparoscopy with aspiration of cavity or cyst (single or multiple) 49322 Use for aspiration of ovarian cyst Laparoscopic appendectomy 44970 There is not an add-on code for laparoscopic appendectomy Laparoscopic enterolysis 44180 Designated as (Separate procedure).

9 Generally not reported in addition to other Surgical codes. If enterolysis is extensive, may report with 59 modifier