If your ob-gyn converts a laparoscopic to an open procedure, your coding for endometrial cancer surgeries can drastically transform. Follow these three steps to ward against denials.

Review This Op Note

Preoperative diagnosis: Adenocarcinoma of the endometrium.

Postoperative diagnosis: Same as above, but greater than 50 percent myometrial invasion, pathology pending.

Operation performed: Laparoscopic assisted transvaginal hysterectomy (LAVH) with bilateral salpingo-oophorectomy, laparotomy with pelvic and periaortic node dissection, partial omentectomy, pelvic washings.

Procedure: Exam of the pelvic organs revealed an 8-week-size uterus. The right and left ovaries appear to be within normal limits. The ob-gyn found no evidence of excrescences or signs of metastatic disease in the lower pelvis along the bowel or serosa, nor did he discover evidence of metastatic disease in the upper abdomen, liver and dome of the diaphragm. He then performed a dissection.

He removed the uterus vaginally with the assistance of the laparoscope, and the pathologist was present to open the organ and render an opinion.

The pathologist saw an enlarged, fungating, relatively superficial lesion of the endometrium. Up in the patient’s right fundal area, however, the pathologist saw an invasion of the myometrium at least two-thirds of the way through. Given this finding, the ob-gyn decided to perform an open pelvic node dissection. He removed the laparoscope and made a new incision to enter the peritoneum.

He obtained pelvic washings from the right cul-de-sac and pelvic area. He then performed a partial omentectomy with the aid of multiple Kelly clamps.

The ob-gyn did a pelvic node dissection, first on the right side identifying the ureter evenly. He carried down the dissection to include the internal and external iliac lymph nodes. He performed the same procedure on the left side. The dissection took place below the bifurcation of the aorta....