CPT® Code 58820

1. Indications

The procedure coded as CPT® 58820 is indicated for the drainage of an ovarian abscess. The specific conditions or symptoms that may warrant this procedure include:

• Ovarian Abscess A localized collection of pus within the ovary, typically due to infection, which may present with symptoms such as pelvic pain, fever, and abnormal vaginal discharge.
• Unruptured Abscess The procedure is specifically indicated for patients with an unruptured ovarian abscess, where the integrity of the abscess has not been compromised, allowing for effective drainage through a transvaginal approach.

2. Procedure

The procedure for drainage of an ovarian abscess using CPT® 58820 involves several critical steps, which are detailed as follows:

• Transvaginal Approach An incision is made in the vaginal wall through the posterior vaginal fornix. This allows access to the ovary via the posterior cul-de-sac. The surgeon carefully incises the abscess, extending the incision into the abscess cavities to facilitate drainage. The septa within the abscess are opened to ensure complete drainage of the pus.
• Abdominal Approach If the transvaginal approach is not feasible, an abdominal incision is made through the skin and subcutaneous tissue. The subcutaneous fat is cleared, and the anterior rectus fascia is incised. The rectus muscles are retracted to expose the transversalis fascia and peritoneum, which are also incised. The abdominal cavity is inspected for any additional abscesses, particularly in the subdiaphragmatic spaces or along the colonic gutters, and the bowel is examined for signs of infection. The bowel is then packed into the upper abdomen to provide access to the ovarian abscess. The abscess is incised, and the incision is carried down into the cavities, with the septa being opened to allow for thorough drainage. Following drainage, the abdomen is irrigated with an antibiotic solution, and drains are placed before closing the abdomen around the drains.

3. Post-Procedure

Post-procedure care following the drainage of an ovarian abscess involves monitoring for any signs of complications, such as infection or bleeding. Patients may require follow-up imaging to ensure that the abscess has been adequately drained and to assess for any recurrence. Pain management and antibiotic therapy may be prescribed to prevent infection and manage discomfort. The presence of drains will require care to ensure they remain patent and function effectively in draining any residual fluid. Patients should be advised on activity restrictions and signs of complications that would necessitate immediate medical attention.