CPT Code 58662 Laparoscopic Excision or Destruction of Ovarian, Tubal, or Peritoneal Lesions (Endometriosis)

In gynecologic surgery, laparoscopic treatment of endometriosis and pelvic lesions is among the most common yet complex procedures to code accurately. CPT 58662 represents the laparoscopic excision or destruction of lesions involving the ovaries, fallopian tubes, or peritoneum, and it’s often performed to manage endometriosis, adhesions, or small cystic lesions.

Because the code applies to both excision and ablation, and is sometimes bundled with other laparoscopic procedures, precise documentation is essential for proper reimbursement and compliance.

Understanding CPT 58662

“Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method.”

This code applies when a physician removes or destroys endometriotic implants or other pathologic lesions from the pelvic organs or peritoneal surfaces using laparoscopic techniques such as excision, cauterization, or laser ablation.

Key Aspects of CPT 58662:

• Approach: Laparoscopic, minimally invasive.
• Target Areas: Ovaries, fallopian tubes, pelvic peritoneum, or other reproductive structures.
• Purpose: To treat endometriosis, adhesions, or small cystic lesions.
• Scope: Includes fulguration (destruction), vaporization, or excision of visible lesions.

Coding Insight: CPT 58662 covers both diagnostic and therapeutic interventions when excision or ablation of lesions is performed. If only diagnostic laparoscopy is done without treatment, use 49320 instead.

When to Use CPT 58662

Report CPT 58662 when the physician performs laparoscopic surgical excision or destruction of one or more pelvic lesions.

Typical Clinical Indications Include:

• Endometriosis (pelvic or ovarian).
• Chronic pelvic pain due to peritoneal implants.
• Infertility associated with tubal or ovarian adhesions.
• Pelvic inflammatory disease sequelae with residual lesions.
• Ovarian or peritoneal cystic formations requiring ablation or excision.

Do not report CPT 58662 when:

• Only diagnostic laparoscopy is performed (use 49320).
• The surgeon performs adhesiolysis alone (use 58660).
• The procedure is incidental to another laparoscopic surgery (e.g., hysterectomy), unless documentation proves it was therapeutic and distinct.

Documentation Requirements

Accurate and detailed documentation is key to defending the service as therapeutic rather than diagnostic.

Ensure operative notes include:

• Diagnosis: Endometriosis, cyst, or pelvic lesion.
• Extent and location: Describe each treated site (ovary, cul-de-sac, uterosacral ligament, etc.).
• Technique used: Fulguration, excision, or ablation (laser, cautery, scissors).
• Number and size of lesions treated.
• Intent: Therapeutic removal rather than diagnostic exploration.
• Complications and findings.

Billing Tip: When multiple lesions are treated, you still report CPT 58662 only once per session. The code already includes treatment of multiple sites.

Reimbursement and Coverage Information

CPT 58662 is considered a major laparoscopic procedure with a 90-day global period.

Average Reimbursement Ranges (Medicare national data):

• Physician Fee (Facility): $950–$1,200
• ASC Payment: $1,500–$1,900
• Hospital Outpatient: $2,100–$2,400

Common ICD-10 Codes Supporting Medical Necessity:

• N80.0–N80.9 – Endometriosis, all sites.
• N73.6 – Female pelvic peritoneal adhesions.
• N83.201–N83.209 – Unspecified ovarian cysts.
• N94.89 – Other specified conditions associated with female genital organs and menstrual cycle.

Modifiers for CPT 58662

Use modifiers carefully to clarify surgical intent or circumstances:

• Modifier 59 – Distinct procedural service (for separate laparoscopic procedure in the same session).
• Modifier 51 – Multiple procedures (if performed with another major surgery).
• Modifier 52 – Reduced service (if incomplete removal due to extensive adhesions or limited access).
• Modifiers 54/55 – Split surgical and postoperative care.

Compliance Note: Do not unbundle 58662 from another code unless the operative report clearly documents that the treated lesions were in a different anatomic area or served a separate purpose.

Example Scenarios

Scenario 1 – Excision of Pelvic Endometriosis

A 33-year-old woman with severe pelvic pain undergoes a laparoscopy. Endometriotic implants are found on the left ovary, right uterosacral ligament, and posterior peritoneum. All visible lesions are excised with scissors and electrocautery.

→ Report CPT 58662.

Scenario 2 – Laparoscopic Ablation of Endometriosis and Salpingectomy

A patient with infertility has endometriotic implants on the pelvic peritoneum and a nonfunctioning right fallopian tube removed during the same session.

→ Report CPT 58662 for endometriosis treatment and CPT 58661 for salpingectomy, using Modifier 59 to indicate distinct procedures.

Scenario 3 – Diagnostic Laparoscopy Without Lesion Removal

The surgeon visualizes endometriosis but does not excise or destroy any lesions.

→ Do not report CPT 58662 - use 49320 for diagnostic laparoscopy only.

Common Coding Challenges and How to Avoid Them

Despite its frequent use, CPT 58662 is one of the most commonly audited laparoscopic codes due to overlapping indications and bundling risks. Here’s how to avoid the pitfalls:

Confusing Diagnostic vs. Therapeutic Procedures

Some surgeons perform laparoscopy to evaluate pelvic pain and happen to note lesions, but do not treat them. Billing 58662 in this case is incorrect - the procedure must involve active excision or ablation.

Tip: If no lesions were removed or destroyed, report 49320 instead.

Bundling Errors During Combined Laparoscopic Procedures

CPT 58662 is frequently performed along with hysterectomy or oophorectomy. If the lesion removal was done in the same field and for the same pathology, it’s bundled and shouldn’t be billed separately.

Tip: Only report 58662 separately if the treated lesions are distinct (for example, endometriosis excised from a different pelvic region).

Overuse or Incorrect Application of Modifier 59

Some practices automatically add Modifier 59 to justify multiple laparoscopic codes. This practice can raise red flags during audits.

Tip: Apply Modifier 59 only when lesions are in separate anatomic sites or when documentation supports a truly independent service.

Missing Details About Lesion Extent

Insufficient documentation about the size, number, or location of treated lesions often leads to payer denials.

Tip: Include operative details like “five 2–5 mm implants excised from left pelvic wall” or “fulguration of multiple peritoneal lesions” for clarity.

Medical Necessity and Prior Authorization Issues

Some payers request documentation showing pain, infertility, or other functional impact before approving payment for 58662.

Tip: Always include the clinical rationale, such as pelvic pain duration, infertility workup results, or imaging findings, to justify the intervention.

By proactively addressing these issues, practices can reduce audit risk and ensure smoother reimbursement.

Partnering with BillingFreedom for OBGYN Billing

Procedures like CPT 58662 require both clinical insight and coding precision. A minor oversight in operative detail or modifier use can result in lost revenue or compliance risks.

At BillingFreedom, our certified team of OBGYN billing experts ensures every laparoscopic procedure is coded with accuracy and supported by complete documentation. Through our OBGYN medical billing services, we help practices:

• Identify billable vs. bundled laparoscopic procedures.
• Apply correct modifiers based on payer-specific rules.
• Strengthen documentation for endometriosis and pelvic surgery claims.
• Reduce denials and improve first-pass claim acceptance rates.

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