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The CPT® Code 58661 refers to a laparoscopic surgical procedure that involves the removal of adnexal structures, which may include either a partial or total oophorectomy (removal of the ovary) and/or salpingectomy (removal of the fallopian tube). This procedure is typically performed through small incisions in the abdomen, utilizing a laparoscope, which is a thin, lighted tube that allows the surgeon to view the internal organs on a monitor. The common language description outlines the steps involved in the procedure, starting with the insertion of a tenaculum into the vagina to grasp the cervix, which helps in positioning the uterus. A periumbilical port is then established, and pneumoperitoneum is created by insufflating the abdominal cavity with air, allowing for better visibility and access to the pelvic organs. The surgeon inspects the abdominal cavity, elevates the fimbrial end of the fallopian tube and ovary, and proceeds to create a window in the peritoneum of the broad ligament. The infundibulopelvic ligament is then grasped, ligated, and transected, followed by the severing of the posterior leaf of the broad ligament up to its attachment to the uterus. The fallopian and ovarian ligaments are coagulated or ligated, and the tube is severed and removed, either with or without the ovary. The procedure concludes with an inspection of the pelvic area for any bleeding, withdrawal of instruments, and closure of the portal incisions. This minimally invasive approach is associated with reduced recovery times and less postoperative pain compared to traditional open surgery.
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The procedure described by CPT® Code 58661 is indicated for various conditions related to the female reproductive system. These may include:
The laparoscopic procedure for CPT® Code 58661 involves several detailed steps to ensure the safe and effective removal of adnexal structures. The process begins with the insertion of a tenaculum into the vagina to grasp the cervix, which aids in positioning the uterus in an anteflexed position. Following this, a periumbilical port is established, and pneumoperitoneum is created by insufflating the abdominal cavity with air, allowing for optimal visualization of the internal structures. Once the laparoscope is inserted, the surgeon inspects the abdominal cavity to assess the condition of the ovaries and fallopian tubes.
Next, the fimbrial end of the fallopian tube and the ovary are elevated to facilitate access. A window is then created in the peritoneum of the broad ligament, which is a fold of peritoneum that supports the uterus, ovaries, and fallopian tubes. The infundibulopelvic ligament, which contains blood vessels supplying the ovary, is grasped, ligated, and transected to prevent bleeding. The posterior leaf of the broad ligament is severed up to its attachment to the uterus, allowing further access to the adnexal structures.
Subsequently, the fallopian and ovarian ligaments are coagulated or ligated using an endoloop at the uterus and then severed. A clip is placed across the superior portion of the broad ligament and at the base of the tube where it connects with the uterus. The fallopian tube is then carefully severed and removed, either along with the ovary or separately, through the endoscopic port. In some cases, the tissue may be placed in an endobag for removal to minimize the risk of spillage. After the removal of the adnexal structures, the pelvic area is inspected for any signs of bleeding. Finally, the instruments are withdrawn, and pressure is applied to the abdomen to express any remaining air from the peritoneum before closing the portal incisions.
Post-procedure care following a laparoscopic removal of adnexal structures typically involves monitoring for any immediate complications such as bleeding or infection. Patients are usually advised to rest and may be prescribed pain management medications to alleviate discomfort. Recovery time can vary, but many patients can resume normal activities within a few days to a week, depending on individual circumstances and the extent of the surgery. Follow-up appointments may be scheduled to ensure proper healing and to address any concerns that may arise during the recovery process. It is important for patients to adhere to their physician's instructions regarding activity restrictions and signs of complications to watch for during their recovery.
| Short Descr | LAPAROSCOPY REMOVE ADNEXA | Medium Descr | LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES | Long Descr | Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy) | Status Code | Active Code | Global Days | 010 - Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 3 - Special payment adjustment rules for multiple endoscopic procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Endoscopic Base Code | 49320 Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 1 | CCS Clinical Classification | 119 - Oophorectomy, unilateral and bilateral |
This is a primary code that can be used with these additional add-on codes.
| 49327 | Addon Code MPFS Status: Active Code APC N ASC N1 Laparoscopy, surgical; with placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), intra-abdominal, intrapelvic, and/or retroperitoneum, including imaging guidance, if performed, single or multiple (List separately in addition to code for primary procedure) |
| 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | GC | This service has been performed in part by a resident under the direction of a teaching physician | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | RT | Right side (used to identify procedures performed on the right side of the body) | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | LT | Left side (used to identify procedures performed on the left side of the body) | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | SG | Ambulatory surgical center (asc) facility service | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 54 | Surgical care only: when 1 physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 to the usual procedure number. | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 81 | Minimum assistant surgeon: minimum surgical assistant services are identified by adding modifier 81 to the usual procedure number. | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AG | Primary physician | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CG | Policy criteria applied | CR | Catastrophe/disaster related | F5 | Right hand, thumb | FP | Service provided as part of family planning program | GA | Waiver of liability statement issued as required by payer policy, individual case | GX | Notice of liability issued, voluntary under payer policy | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GZ | Item or service expected to be denied as not reasonable and necessary | KX | Requirements specified in the medical policy have been met | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | SA | Nurse practitioner rendering service in collaboration with a physician | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2024-01-01 | Changed | Guideline added. |
| 2011-01-01 | Changed | Short description changed. |
| 2000-01-01 | Added | First appearance in code book in 2000. |
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