CPT Code 58825 Incision Procedures on the Ovary

CPT 58825 refers to the surgical relocation of one or both ovaries to a new position within the pelvis or abdomen. This open surgical procedure, also called ovarian transposition or oophoropexy, is typically performed to protect ovarian function before pelvic radiation therapy or extensive pelvic surgery that could compromise blood flow or lead to adhesions.

Description of the Procedure

During an ovarian transposition, the surgeon makes an abdominal incision (via laparotomy) and carefully identifies the ovary and its vascular supply. The ovary is mobilized, keeping the blood vessels intact, and then moved to a new location, often outside the radiation field or behind the uterus. It is then sutured in place to prevent torsion or migration.

This surgery is most commonly indicated for patients undergoing pelvic radiation therapy for malignancies such as cervical, rectal, or endometrial cancer. By repositioning the ovaries, the procedure helps preserve hormonal function and fertility potential.

When to Use CPT 58825

CPT 58825 should be reported when the physician performs a surgical transposition (repositioning) of one or both ovaries, usually as a protective or preventive measure.

Typical indications include:

• Planned pelvic or abdominal radiation therapy where ovarian exposure could lead to loss of function.
• Extensive pelvic or gynecologic surgery with a high risk of postoperative adhesions.
• Ovarian repositioning to preserve endocrine function or fertility potential in premenopausal women.
• Preventive surgery for patients with pelvic malignancy requiring hysterectomy or lymphadenectomy.

Do not report CPT 58825 if the approach is laparoscopic; use CPT 58662 or 58679 (unlisted laparoscopy) if applicable.

This code is specific to open surgical transposition procedures.

Key Coding Considerations

• Report once per surgical session, even if both ovaries are transposed.
• An open approach only; laparoscopic ovarian transposition is not reported with this code.
• Global period: 90 days (includes postoperative care).
• Setting: Usually performed in a hospital setting, sometimes alongside oncologic or reconstructive surgery.
• Prior authorization: Strongly recommended for fertility-preserving or prophylactic surgeries.

Modifiers

Proper modifier use ensures accurate claim submission and payment clarity:

• Modifier 50 – Bilateral procedure (if both ovaries are transposed).
• Modifier 51 – When performed with other major procedures (e.g., hysterectomy).
• Modifier 59 – Distinct procedural service, if done separately from the main procedure.
• Modifier 54/55 – Split surgical and postoperative care.
• Modifier LT/RT – If required by payer to indicate laterality.

Documentation Requirements

Comprehensive documentation is crucial for correct reimbursement and audit readiness. The operative note should clearly describe:

• Medical necessity (e.g., radiation planning or risk to ovarian function).
• Approach used (open laparotomy).
• Laterality (right, left, or bilateral).
• Details of the ovarian relocation (new position, distance from radiation field).
• Surgical technique and fixation method.
• Preservation of ovarian vasculature.
• Coordination with oncology or radiation teams.

Accurate, detailed operative notes not only support reimbursement but also demonstrate the clinical justification for ovarian preservation.

Reimbursement and Billing Information

According to CMS and payer-specific data, CPT 58825 is recognized as a major surgical procedure with a 90-day global period.

• Setting: Inpatient or outpatient hospital setting.
• Relative value: Higher complexity due to surgical precision and coordination with oncology care.
• Average reimbursement: Variable, depending on payer and region, but typically consistent with other open gynecologic preservation procedures.
• Bundling rules: Often bundled when performed in conjunction with hysterectomy or lymph node dissection, review payer-specific edits.

Common Coding Challenges

Accurate reporting of CPT 58825 can be tricky because it often occurs in complex, multidisciplinary surgical settings involving oncology, reproductive, or reconstructive teams. Below are the most common challenges and practical guidance to overcome them:

Confusion Between Procedure Types

Many coders mistake ovarian transposition for other adnexal procedures, such as oophoropexy for torsion or adhesiolysis. Always confirm that the intent of surgery was protective relocation of the ovary, not fixation or untwisting. The operative note should clearly state “transposition” or “repositioning” with the reason (e.g., radiation protection).

Approach Misidentification (Open vs. Laparoscopic)

CPT 58825 applies only to open procedures performed via laparotomy. If the surgery was laparoscopic, it must be reported differently, typically with an unlisted laparoscopy code (58679). Review the operative approach before finalizing code selection.

Bundling with Major Pelvic Surgeries

Ovarian transposition is often performed during hysterectomy, lymphadenectomy, or tumor resection. Payers may bundle the procedure unless proper modifier use (e.g., -51 or 59) and detailed operative notes establish it as a distinct service. Clearly document the additional time, complexity, and purpose of the transposition.

Incomplete Documentation of Medical Necessity

One of the most common audit triggers is a missing rationale for ovarian preservation. The operative or preoperative documentation should explain why the ovary needed relocation, such as upcoming radiation therapy or fertility preservation intent.

Laterality Errors and Modifier Misuse

Since ovarian transposition can be unilateral or bilateral, laterality must always be specified. Use modifier LT, RT, or 50 accordingly. Failing to document which ovary was moved can result in denials or claim ambiguity.

Coordination With Oncology or Radiation Planning

Sometimes, payer reviewers request evidence of multidisciplinary coordination. Make sure the operative report or preauthorization request references oncology consultation or treatment planning notes to support the necessity of the transposition.

ICD-10 Coding Guidance

When reporting CPT 58825, diagnosis codes should reflect the reason for ovarian transposition, such as:

• Pelvic malignancy requiring radiation (e.g., cervical, uterine, rectal cancer).
• Prophylactic ovarian protection during pelvic surgery.
• Adhesive disease or structural conditions threatening ovarian viability.
• Fertility preservation prior to oncology treatment.

Tip: Link the ICD-10 diagnosis directly to the medical necessity, preserving ovarian function or fertility, to strengthen claim justification.

Example Clinical Scenarios

Scenario 1 – Radiation Protection:

A 30-year-old patient with cervical cancer is scheduled for pelvic radiation. During surgery, both ovaries are transposed behind the uterus and fixed in place to prevent radiation damage. → Report CPT 58825 with modifier 50.

Scenario 2 – Fertility Preservation:

A young patient undergoing pelvic tumor resection has the left ovary repositioned to maintain hormonal function and fertility. → Report CPT 58825-LT.

Scenario 3 – Combined Procedure:

During a radical hysterectomy for endometrial cancer, the surgeon transposes both ovaries outside the radiation field. → Report CPT 58150 and CPT 58825-51.

Partner with BillingFreedom for Stress-Free OBGYN Revenue Success

Billing for complex OBGYN surgeries like ovarian transposition (CPT 58825) demands more than just coding accuracy; it requires strategy, precision, and proactive revenue protection. That’s where BillingFreedom stands apart.

Our team of certified OBGYN medical billing experts combines in-depth procedural knowledge with real-world payer insight to help your practice:

• Capture every eligible dollar through compliant, error-free coding and accurate modifier use.
• Prevent denials before they happen with detailed documentation review and payer-specific claim scrubbing.
• Stay compliant and audit-ready with the latest CMS and AAPC updates built into every submission.
• Reclaim your time so your focus returns to patient care, not paperwork and payment delays.

Whether you’re a solo OBGYN, part of a group practice, or managing a surgical center, BillingFreedom ensures your claims flow smoothly and your revenue cycle stays strong.

For more details about our exceptional medical billing services, please don't hesitate to contact us via email at info@billingfreedom.com or call us at +1 (855) 415-3472. 

Your financial tranquility is our priority!