Common Surgical Procedures Gyn/Oncology

Malignancy Description Codes wRVU Comments Cervical Typical Open Cone biopsy 57520 4.11 Leep conization 57522 3.67 /Leep 57461 3.43 TAH +/ - BSO 58150 17.31 Radical 58210 30.91 Includes excision of parametria and +/- BSO ureteral dissection. Pelvic lymphadenectomy (Total, bilateral) Can be used for TAH PLND Para-aortic sampling Radical trachelectomy 57531 29.95 +/-BSO Pelvic lymphadenectomy (Total bilateral) Para-aortic sampling Cervical Less Common Open Radical vaginal hyst (Schauta) 58285 23.38 Includes excision of parametria and ureteral dissection Modifier 52 fertility sparing +/- nodes Radical 57107 24.56 Includes removal of paravaginal tissue Partial removal wall Partial Vaginectomy use 57106 Radical vaginectomy 57109 28.40 Includes removal of paravaginal tissue Partial removal wall Pelvic lymphadenectomy (Total bilateral) Para-aortic sampling Radical vaginectomy 57111 28.40 Includes removal of paravaginal t issue Complete removal wall Complete vaginectomy 57110 Radical vaginectomy 57112 30.52 Includes removal of paravaginal tissue Complete removal wall Pelvic lymphadenectomy (Total bilateral) Para-aortic sampling Pelvic lymphadenectomy 387 70 14.06 Use modifier 50 for bilateral procedure External iliac Hypogastric/Obturator Cervical Laparoscopic Radical hysterectomy 58548 31.63 +/- BSO Pelvic lymphadenectomy (Total bilateral) Para-aortic sampling Pelvic lymphadenectomy 38571 14.76 (Total bilateral) Pelvic lymphaden ectomy 38572 16.94 (Total bilateral) Para-aortic sampling

1 Common Surgical Procedures Gyn/Oncology

Malignancy Description Codes wR VU Comments Endometrial Open TAH +/ - BSO 58150 17.31 TAH +/ - BSO 58200 23.10 P&P sampling Radical hysterectomy 58210 30.91 Includes excision of parametria and +/- BSO ureteral dissection. Pelvic lymphadenectomy Can be used for TAH PLND (Total, bilateral) Para-aortic sampling TAH/BSO 58953 34.13 Omentectomy Debulking TAH/BSO 58954 37.13 Omentectomy Debulking Pelvic lymphadenectomy Limited para-aortic lymphadenectomy TAH/BSO 58956 22.80 Code indicates used for malignancy only Omentectomy TAH/BSO 58210 - 30.91 Increase fee to reflect use of modifier 22 P&P nodes 22 Omentectomy Endometrial Laparoscopic LAVH <250gms 58550 15.10 LAVH BSO 58552 16.91 LAVH >250gms 58553 20.06 LAVH BSO 58554 23.11 TLH <250gms 58570 15.88 TLH BSO 58571 17.69 TLH >250gms 58572 20.09 TLH BSO 58573 23.11 Endometrial Laparoscopic Nodes Retroperitoneal sampling 38570 9.34 Single or multiple node s Pelvic lymphadenectomy 38571 14.76 (Total bilateral) Pelvic lymphadenectomy 38572 16.94 Single or multiple nodes (Total bilateral) Para-aortic sampling

2 Common Surgical Procedures Gyn/Oncology

Malignancy Description Codes wR VU Comments Ovarian/ Open Peritoneal 58943 19.52 Partial or total oophorectomy, unilateral P&P node sampling or bilateral Peritoneal biopsies/washings Specific for ovarian, tubal, or primary +/- peritoneal malignancy +/- omentectomy BSO 58950 18.37 Initial resection of ov arian, tubal, or Omentectomy primary peritoneal malignancy TAH/BSO 58951 24.26 Initial resection of ovarian, tubal, or Omentectomy primary peritoneal malignancy Pelvic lymphadenectomy Limited para-aortic lymphadenectomy BSO 58952 27.29 Initial resection of ovarian, tubal, or Omentectomy primary peritoneal malignancy Debulking (radical dissection) Radical excision/destruction intra- abdominal or retroperitoneal tumors TAH/BSO, 58953 34.13 All sites Omentectomy Debulking (radical dissection) TAH/BSO 58954 37.13 All sites Omentectomy Debulking (radical dissection) Pelvic lymphadenectomy Limited para-aortic lymphadenectomy TAH/BSO 58956 22.80 All sites Omentectomy Debulking 58957 26.22 Recurrent gyn resection +/- omentectomy Debulking 58958 29.22 Recurrent gyn resection +/- omentectomy Pelvic lymphadenectomy Limited para-aortic lymphadenectomy Staging (second look) 58960 15.79 Specific for ovarian, tubal, or primary +/- omentectomy peritoneal malignancy Biopsy abd/pelvic Pelvic and limited para-aortic lymphadenectomy Ovarian/ Laparoscopic Peritoneal Second look with biopsy 49321 5.44 No codes for debulking: unlisted With nodes 38572 16.94 Staging 49320 5.14 22 modifier as appropriate 38572 16.94

3 Common Surgical Procedures Gyn/Oncology

Malignancy Description Code wR VU Comments Vaginal Open Vaginectomy, partial 57106 7.50 Vaginectomy, partial 57107 24.56 Removal of paravaginal tissue (radical) Vaginectomy, partial 57109 28.40 Removal of paravaginal tissue (radical) Bilateral total pelvic lymphadenectomy Para-aortic lymph node sampling Vaginectomy, complete 57110 15.48 Vaginectomy, complete 57111 28.40 Removal of paravaginal tissue (radical) Vaginectomy, complete 57112 30.52 Removal of paravaginal tissue (radical) Bilateral total pelvic lymphadenectomy Para-aortic lymph node sampling Biopsy of vaginal mucosa, simple 57100 1.20 Biopsy of vaginal mucosa, extensive 57105 1.74 Requires sutures Includes cysts Destruction of lesion(s), simple 57061 1.30 Destruction of lesion(s), extensive 57065 2.66

4 Common Surgical Procedures Gyn/Oncology

Maligna ncy Description Code wR VU 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: Removal of >80% vulvar area r Open Vulvectomy, simple, partial 56620 7.53 Vulvectomy, simple, complete 56625 9.68 Vulvectomy, radical, partial 56630 14.80 Vulvectomy, radical, partial 56631 18.99 Unilateral inguinofemoral lymphadenectomy Vulvectomy, radical, partia l 56632 21.86 Bilateral inguinofemoral lymphadenectomy Vulvectomy, radical, complete 56633 19.62 Vulvectomy, radical, complete 56634 20.66 Unilateral inguinofemoral lymphadenectomy Vulvectomy, radical, complete 56637 24.75 Bilateral inguinofemoral lymphadenectomy Vulvectomy, radical, complete 56640 24.78 Inguinofemoral lymphadenectomy Iliac lymphadenectomy Pelvic lymphadenectomy Biopsy vulva or perineum; 1 lesion 56605 1.10 Biopsy of each additional lesion vulva or +56606 0.55 Add on code. Use with 56605 perineum Excision benign lesion of genitalia 11420 - Varies Based on excised diameter. 11426 by Use if skin not excised. code Excision malignant lesion of genitalia 11620 - Varies Based on excised diameter. 11626 by Use if skin not excised. code Intermediate repair code genitalia 12041 - Varies Use in conjunction with 11420 -11426 12047 by and 11620-11626 if layered closure code required

5 Common Surgical Procedures Gyn/Oncology

Malignancy Description Code wR VU Comments Bowel Open Procedures Partial Partial col ectomy with anastomosis 44140 22.59 Colectomy Partial colectomy 44141 29.91 Skin level cecostomy or colostomy Partial colectomy 44143 27.79 End colostomy and closure of distal segment (Hartmann type procedure) Partial colectomy 44144 29.91 Resection, with colostomy or ileostomy Creation of mucofistula Partial colectomy 44145 28.58 Coloproctostomy (low pelvic anastomosis) Partial colectomy 44146 35.30 Coloproctostomy (low pelvic anastomosis) Colostomy Partial colectomy 44147 33.69 Abdominal and Transanal approach

Mobilization (take -down) of splenic +44139 2.23 Add on code. Use with 44140 -44147 flexure Colectomy, partial 44160 20.89 Removal of terminal ileum with ileocolostomy Total Colectomy, total 44150 30.18 Colectomy Ileostomy or ileoproctostomy Total colectomy 44151 34.92 Continent ileostomy Total colectomy 44155 34.42 Proctectomy Ileostomy Total colectomy 44156 37.42 Proctectomy Continent ileostomy Total colectomy 44157 35.70 Includes loop ileostomy, and rectal Proctectomy mucosectomy, when performed Ileoanal anastomosis, Total colectomy 44158 36.70 Includes loop ileostomy, and rectal Proctectomy mucosectomy, when performed Ileoanal anastomosis Creation of ileal reservoir (S or J) Enterectomy Small bowel resection 44120 20.82 Each additional resection and +44121 4.44 Add -on code. Use with 44120 anastomosis Small bowel resection 44125 20.03 Enterostomy

6 Common Surgical Procedures Gyn/Oncology

Malignancy Description Code wR VU Comments Bowel Laparoscopic Procedures Laparoscopic enterectomy 44202 23.39 Single resection of small intestine Anastomosis Each additional small intestine resection +44203 4.44 Add -on code. Use with 44202 and anastomosis Laparoscopic partial colectomy Anastomosis 44204 26.42 Laparoscopic partial colectomy 44205 22.95 Removal of terminal ileum Ileocolostomy Laparoscopic partial colectomy 44206 29.79 End colostomy and closure of distal segment (Hartmann type procedure) Laparoscopic partial colectomy 44207 31.92 Coloproctostomy (low pelvic anastomosis) Laparoscopic partial colectomy 44208 33.99 Coloproctostomy (low pelvic anastomosis) Colostomy Laparoscopy mobilization (take -down) of +44213 3.50 Add -on code. Use with 44204 -44208 splenic flexure

7 Common Surgical Procedures Gyn/Oncology

Malignancy Description Code wR VU Comments Other Open Procedures Exploratory laparotomy 49000 12.54 Includes biopsies if performed Excision or destruction, open, intra -abdominal 49203 20.13 Codes appropriate when primary organs tumors, cysts or endometriomas, 1 or more have been removed. peritoneal, mesenteric, or retroperitoneal primary If ovarian tumor, use appropriate ovarian or secondary tumors; largest tumor 5 cm diameter tumor or BSO code. or less Largest tumor 5.1 -10.0 cm diameter 49204 26.13 Largest tumor greater than 10.0 cm diameter 492 05 30.13 Appendectomy ; 44950 10.60 For indicated purpose at time of major +44955 1.53 Add -on code. Report in addition to procedure primary surgical procedure Enterolysis 44005 18.46 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 50715 20.64 Must have diagnosis of retroperitoneal ureter for retroperitoneal fibrosis fibrosis to report. Typically, ureterolysis is included in major surgical procedure. Other Laparoscopy Procedures Diagnostic laparoscopy 49320 5.14 Laparoscopy with biopsy 49321 5.44 Use for ovarian biopsy Laparoscopy with aspiration of cavity or cyst 4932 2 6.01 Use for aspiration of ovarian cyst (single or multiple) Laparoscopic appendectomy 44970 9.45 There is not an add -on code for laparoscopic appendectomy Laparoscopic enterolysis 44180 15.27 Designated as (Separate procedure). Generally not reported in addition to other surgical codes. If enterolysis is extensive, may report with 59 modifier

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