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Official Description

Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy; with total abdominal hysterectomy, pelvic and limited para-aortic lymphadenectomy

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The CPT® Code 58951 refers to a surgical procedure involving the resection of ovarian, tubal, or primary peritoneal malignancies, which is performed in conjunction with a bilateral salpingo-oophorectomy and omentectomy, as well as a total abdominal hysterectomy, pelvic, and limited para-aortic lymphadenectomy. This complex procedure is typically indicated for patients diagnosed with malignancies in the ovaries, fallopian tubes, or peritoneum, where the extent of the disease necessitates a comprehensive surgical approach to remove affected tissues and organs. The surgery begins with an incision in the abdomen, allowing the surgeon to explore the abdominal and pelvic cavities to assess the malignancy's spread. The procedure involves meticulous dissection to remove the ovaries, fallopian tubes, and omentum, while also addressing any metastatic disease present. The total abdominal hysterectomy component entails the removal of the uterus and cervix, along with the associated ligaments and blood vessels. Additionally, the pelvic and para-aortic lymph nodes are examined and excised as necessary to ensure comprehensive treatment of the malignancy. This procedure is critical for managing advanced gynecological cancers and aims to achieve optimal tumor debulking while preserving as much surrounding healthy tissue as possible.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 58951 is indicated for the following conditions:

  • Ovarian Malignancy - The presence of cancerous tumors in the ovaries that require surgical intervention for removal.
  • Tubal Malignancy - Cancer affecting the fallopian tubes, necessitating resection to manage the disease effectively.
  • Primary Peritoneal Malignancy - Tumors originating in the peritoneum, which may require extensive surgical resection to eliminate cancerous tissue.

2. Procedure

The procedure involves several critical steps to ensure the effective resection of malignancies:

  • Initial Exploration - The abdomen is opened from the symphysis pubis to the xiphoid, allowing for exploration of the abdominal and pelvic cavities to assess the extent of the malignancy.
  • Dissection of Ligaments - Blunt dissection is performed to expose the broad ligament, round ligament, ovaries, and fallopian tubes. An incision is made in the broad ligament, and the ovarian vessels are visualized and suture ligated.
  • Plicating the Broad Ligament - The cut edges of the broad ligament are plicated with mattress sutures to secure the area post-resection.
  • Removal of Ovaries and Tubes - The fallopian tubes and ovaries are carefully dissected free from surrounding tissue, with the round ligaments clamped and divided, and blood vessels ligated bilaterally.
  • Resection of Malignancy - If the resection is for a primary peritoneal malignancy, the tumor is excised. For ovarian or tubal malignancies, as much metastatic disease as possible is removed.
  • Omentectomy - The omentum is removed, starting from the greater curvature of the stomach, ensuring control of bleeding from the omental branches of the right gastric artery.
  • Pelvic and Para-Aortic Lymphadenectomy - Before opening the peritoneum, pelvic lymph nodes are explored and excised, preserving the genitofemoral nerve and psoas muscle. Fatty tissue is stripped from the common iliac vessels, and lymph nodes are sent for frozen section examination.
  • Total Abdominal Hysterectomy - The uterus, cervix, fallopian tubes, and ovaries are removed through a total abdominal hysterectomy, with careful dissection of the uterine artery and vein, and ligation of the ureters.
  • Closure of the Abdomen - After all necessary resections, the abdomen is closed in layers to ensure proper healing.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any complications related to the extensive surgical intervention. Patients may require pain management and close observation for signs of infection or bleeding. Recovery typically involves a hospital stay, during which the surgical site is assessed, and any necessary follow-up imaging or laboratory tests are conducted to evaluate the success of the resection and monitor for any residual disease. Patients are advised on activity restrictions and follow-up appointments to ensure proper healing and management of any ongoing treatment needs.

Short Descr RESECT OVARIAN MALIGNANCY
Medium Descr RESCJ PRIM PRTL MAL W/BSO & OMNTC TAH & LMPHAD
Long Descr Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy; with total abdominal hysterectomy, pelvic and limited para-aortic lymphadenectomy
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 2 - 150% payment adjustment does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62) 1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Inpatient Procedures, not paid under OPPS
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P1G - Major procedure - Other
MUE 1
CCS Clinical Classification 124 - Hysterectomy, abdominal and vaginal

This is a primary code that can be used with these additional add-on codes.

96547 Add On Code MPFS Status: Active Code APC N Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) procedure, including separate incision(s) and closure, when performed; first 60 minutes (List separately in addition to code for primary procedure)
96548 Add On Code MPFS Status: Active Code APC N Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) procedure, including separate incision(s) and closure, when performed; each additional 30 minutes (List separately in addition to code for primary procedure)
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
62 Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
82 Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).
AQ Physician providing a service in an unlisted health professional shortage area (hpsa)
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
GC This service has been performed in part by a resident under the direction of a teaching physician
Q6 Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
Date
Action
Notes
2013-01-01 Changed Medium Descriptor changed.
2007-01-01 Changed Code description changed.
2001-01-01 Changed Code description changed.
Pre-1990 Added Code added.
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