Yes, under very specific circumstances, it may be possible to bill CPT codes 58661 and 58662 together, provided certain conditions are met and the payer's policy allows for it.
Understanding the CPT Codes
To understand when these codes can be billed together, it's important to know what each code represents in the context of laparoscopic gynecological procedures:
- CPT 58661: Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy). This code typically refers to the surgical removal of an ovary and/or fallopian tube.
- CPT 58662: Laparoscopy, surgical; with removal of ovarian cyst(s). This code covers the laparoscopic removal or aspiration of one or more ovarian cysts.
Conditions for Billing Both Codes
Billing both 58661 and 58662 simultaneously is not a routine practice and hinges on distinct procedures performed on different anatomical sites during the same operative session. The key scenario allowing for this combined billing involves laterality:
- Distinct Surgical Sites: A physician might perform a laparoscopic oophorectomy (removal of an ovary, coded as 58661) on one side (e.g., the right ovary).
- Separate Procedure on Contralateral Side: During the same procedure, they might also perform a laparoscopic removal or aspiration of an ovarian cyst (coded as 58662) on the other side (e.g., the left ovary).
This means one procedure addresses the removal of an entire adnexal structure (ovary/tube) on one side, while the other addresses only the removal or aspiration of a cyst from the opposite ovary.
The Role of Modifiers and Payer Agreement
For this billing combination to be considered, specific modifiers are crucial, and payer agreement is paramount:
- Laterality Modifiers: When these procedures are performed on opposite sides, it is necessary to append laterality modifiers to indicate the distinct anatomical sites. The
-RTmodifier denotes the right side, and the-LTmodifier denotes the left side. For example, 58661-RT for the right ovary removal and 58662-LT for the left ovarian cyst removal. - Payer Policy: Even with the correct use of modifiers, the ultimate decision rests with the individual payer. Insurance carriers may have specific policies or interpretations regarding the simultaneous billing of these codes. It is essential to verify with the payer beforehand to ensure reimbursement.
The following table summarizes the key aspects of billing these codes together:
| CPT Code | Description (Contextual) | Unilateral Procedure | Contralateral Procedure | Required Modifiers | Payer Policy |
|---|---|---|---|---|---|
| 58661 | Laparoscopic Oophorectomy | Removal of an ovary on one side | N/A | -RT or -LT | Requires agreement |
| 58662 | Laparoscopic Ovarian Cystectomy | N/A | Removal/aspiration of an ovarian cyst on the other side | -RT or -LT | Requires agreement |
Practical Considerations
- Documentation is Key: Thorough and clear operative notes are vital. The documentation must clearly differentiate the procedures performed on each side, justifying the use of both codes.
- Medical Necessity: Each procedure must be medically necessary and distinctly documented for its respective indication.
- Consult Payer Guidelines: Always refer to the specific payer's manual or contact their provider services to confirm their policy on billing these codes together, especially for bilateral, distinct procedures. Guidelines can vary significantly among payers.
For general information on CPT codes and medical billing best practices, healthcare providers often refer to resources from organizations like the American Medical Association (AMA) or other reputable coding associations.
