Laparoscopic treatment of endometriosis and pelvic lesions is one of the most frequently performed and most frequently misbilled procedures in GYN surgery. Getting CPT 58662 right matters, since it's also one of the more heavily audited laparoscopic codes on the books.
What CPT 58662 Actually Covers
CPT 58662 is defined as laparoscopic surgery involving fulguration (destruction) or excision of lesions on the ovary, pelvic viscera, or peritoneal surface, by any method. In plain terms: it covers a surgeon going in laparoscopically and either cutting out or destroying (via cautery, laser, or similar) visible lesions, most often endometriosis implants, but also adhesions or small cystic growths.
A few things worth knowing up front:
- It's a "by any method" code. Whether the surgeon uses scissors, electrocautery, or laser ablation, it's still 58662, the technique doesn't change the code.
- It's billed once per session, regardless of lesion count. Per AMA CPT Assistant guidance, 58662 covers destruction or excision of any and all lesions across the ovary, pelvic viscera, and peritoneal surface; you don't report it multiple times because five implants were treated instead of one.
- It carries a 90-day global period and a physician work RVU of roughly 12.15, reflecting its status as a major laparoscopic procedure useful context when you're evaluating whether a claim's reimbursement looks right.
When 58662 Applies and When It Doesn't
Report 58662 when the surgeon actively treats one or more pelvic lesions during laparoscopy. Typical scenarios include:
- Endometriosis, pelvic or ovarian
- Chronic pelvic pain traced to peritoneal implants
- Infertility linked to tubal or ovarian adhesions
- Residual lesions from prior pelvic inflammatory disease
- Ovarian or peritoneal cysts requiring ablation or excision
Don't report 58662 when:
- Only diagnostic laparoscopy was performed with no treatment, that's 49320.
- The surgeon performed adhesiolysis only, with no lesion excision or destruction, that's 58660.
- The lesion treatment was incidental to a separate primary procedure (like a hysterectomy) in the same field, unless documentation clearly supports it as a distinct, therapeutic service.
This diagnostic-vs-therapeutic line is where most coding errors happen. A surgeon can visualize and note endometriosis without treating it, if nothing was excised or destroyed, 58662 doesn't apply, full stop.
Documentation That Actually Holds Up in Review
Because 58662 sits at the intersection of "commonly used" and "commonly audited," documentation quality is what separates a clean claim from a denial. Operative notes should clearly establish:
- The diagnosis driving the procedure (endometriosis, cyst, pelvic lesion)
- Where each treated lesion was located (ovary, cul-de-sac, uterosacral ligament, etc.)
- The technique used excision, fulguration, or laser ablation
- How many lesions were treated and their approximate size
- That the intent was therapeutic removal, not exploratory visualization
- Any complications or additional findings
Vague notes like "endometriosis treated laparoscopically" without specifics on location, technique, and lesion count are a common source of payer pushback.
Modifiers Worth Getting Right
- Modifier 59 — distinct procedural service, used when a separate laparoscopic procedure was performed in the same session at a genuinely distinct site
- Modifier 51 — multiple procedures, when 58662 is billed alongside another major surgery
- Modifier 52 — reduced service, if extensive adhesions or limited access prevented complete lesion removal
- Modifiers 54/55 — used to split surgical care from postoperative management between providers
One pattern payers flag consistently: modifier 59 applied reflexively to justify billing multiple laparoscopic codes together, without documentation showing the services were truly separate. Use it when the record supports it — not as a default habit.
Two Quick Scenarios
Scenario 1: A patient with pelvic pain undergoes laparoscopy. Endometriotic implants are excised from the left ovary, right uterosacral ligament, and posterior peritoneum using scissors and electrocautery. → Report 58662 once, regardless of the three separate sites treated.
Scenario 2: During the same session, a surgeon treats peritoneal endometriosis and removes a nonfunctioning fallopian tube (salpingectomy). → Report 58662 for the lesion treatment and 58661 for the salpingectomy, with modifier 59 to indicate they're distinct services.
Scenario 3: The surgeon visualizes endometriotic implants during laparoscopy but doesn't treat them. → 58662 doesn't apply here, use 49320 for the diagnostic laparoscopy instead.
Where Claims Usually Go Wrong
Billing 58662 for diagnostic-only findings. If nothing was excised or destroyed, this code isn't supported regardless of how detailed the visual findings section is.
Bundling conflicts during combined procedures. When 58662 is performed alongside a hysterectomy or oophorectomy for the same pathology in the same field, it's typically bundled rather than billed separately. Separate billing is only supported when the treated lesions are in a genuinely distinct pelvic region.
Reflexive modifier 59 use, as noted above, apply it based on documented distinctness, not as a workaround to get two codes paid.
Thin lesion-extent documentation. "Multiple lesions excised" tells a payer very little. "Four 3–5mm implants excised from the left pelvic sidewall and posterior cul-de-sac" tells them what they need to see.
Missing medical necessity context. Some payers want to see documented pain history, infertility workup findings, or imaging results before they'll approve 58662, not just the operative note.
Commonly Linked Diagnosis Codes
CPT 58662 is most often supported by ICD-10-CM codes across the N80 endometriosis series (site-specific, from N80.00 through N80.9 and the newer nerve-specific N80.D0–N80.D9 codes), N73.6 for pelvic peritoneal adhesions, N83.201–N83.299 for ovarian cysts, and N94.89 for other specified conditions tied to the female genital organs. The exact supporting code should match the documented pathology, not be selected generically.
Related ICD-10-CM Codes
- C48.1 - Malignant neoplasm of specified parts of peritoneum
- C48.2 - Malignant neoplasm of peritoneum, unspecified
- C48.8 - Malignant neoplasm of overlapping sites of retroperitoneum and peritoneum
- C56.1 - Malignant neoplasm of right ovary
- C56.2 - Malignant neoplasm of left ovary
- C56.3 - Malignant neoplasm of bilateral ovaries
- C56.9 - Malignant neoplasm of unspecified ovary
- C78.6 - Secondary malignant neoplasm of retroperitoneum and peritoneum
- C79.60 - Secondary malignant neoplasm of unspecified ovary
- C79.61 - Secondary malignant neoplasm of right ovary
- C79.62 - Secondary malignant neoplasm of left ovary
- C79.63 - Secondary malignant neoplasm of bilateral ovaries
- C7B.04 - Secondary carcinoid tumors of peritoneum
- D19.1 - Benign neoplasm of mesothelial tissue of peritoneum
- D27.0 - Benign neoplasm of right ovary
- D27.1 - Benign neoplasm of left ovary
- D27.9 - Benign neoplasm of unspecified ovary
- D39.10 - Neoplasm of uncertain behavior of unspecified ovary
- D39.11 - Neoplasm of uncertain behavior of right ovary
- D39.12 - Neoplasm of uncertain behavior of left ovary
- D48.4 - Neoplasm of uncertain behavior of peritoneum
- E28.2 - Polycystic ovarian syndrome
- K66.8 - Other specified disorders of peritoneum
- N73.6 - Female pelvic peritoneal adhesions (postinfective)
- N80.00 - Endometriosis of the uterus, unspecified
- N80.01 - Superficial endometriosis of the uterus
- N80.02 - Deep endometriosis of the uterus
- N80.03 - Adenomyosis of the uterus
- N80.101 - Endometriosis of right ovary, unspecified depth
- N80.102 - Endometriosis of left ovary, unspecified depth
- N80.103 - Endometriosis of bilateral ovaries, unspecified depth
- N80.109 - Endometriosis of ovary, unspecified side, unspecified depth
- N80.111 - Superficial endometriosis of right ovary
- N80.112 - Superficial endometriosis of left ovary
- N80.113 - Superficial endometriosis of bilateral ovaries
- N80.119 - Superficial endometriosis of ovary, unspecified ovary
- N80.121 - Deep endometriosis of right ovary
- N80.122 - Deep endometriosis of left ovary
- N80.123 - Deep endometriosis of bilateral ovaries
- N80.129 - Deep endometriosis of ovary, unspecified ovary
- N80.201 - Endometriosis of right fallopian tube, unspecified depth
- N80.202 - Endometriosis of left fallopian tube, unspecified depth
- N80.203 - Endometriosis of bilateral fallopian tubes, unspecified depth
- N80.209 - Endometriosis of unspecified fallopian tube, unspecified depth
- N80.221 - Deep endometriosis of right fallopian tube
- N80.222 - Deep endometriosis of left fallopian tube
- N80.223 - Deep endometriosis of bilateral fallopian tubes
- N80.229 - Deep endometriosis of unspecified fallopian tube
- N80.30 - Endometriosis of pelvic peritoneum, unspecified
- N80.311 - Superficial endometriosis of the anterior cul-de-sac
- N80.312 - Deep endometriosis of the anterior cul-de-sac
- N80.319 - Endometriosis of the anterior cul-de-sac, unspecified depth
- N80.321 - Superficial endometriosis of the posterior cul-de-sac
- N80.322 - Deep endometriosis of the posterior cul-de-sac
- N80.329 - Endometriosis of the posterior cul-de-sac, unspecified depth
- N80.341 - Deep endometriosis of the right pelvic sidewall
- N80.342 - Deep endometriosis of the left pelvic sidewall
- N80.343 - Deep endometriosis of the bilateral pelvic sidewall
- N80.349 - Deep endometriosis of the pelvic sidewall, unspecified side
- N80.351 - Endometriosis of the right pelvic sidewall, unspecified depth
- N80.352 - Endometriosis of the left pelvic sidewall, unspecified depth
- N80.353 - Endometriosis of bilateral pelvic sidewall, unspecified depth
- N80.359 - Endometriosis of pelvic sidewall, unspecified side, unspecified depth
- N80.371 - Deep endometriosis of the right pelvic brim
- N80.372 - Deep endometriosis of the left pelvic brim
- N80.373 - Deep endometriosis of bilateral pelvic brim
- N80.379 - Deep endometriosis of the pelvic brim, unspecified side
- N80.381 - Endometriosis of the right pelvic brim, unspecified depth
- N80.382 - Endometriosis of the left pelvic brim, unspecified depth
- N80.383 - Endometriosis of bilateral pelvic brim, unspecified depth
- N80.389 - Endometriosis of the pelvic brim, unspecified side, unspecified depth
- N80.391 - Superficial endometriosis of the pelvic peritoneum, other specified sites
- N80.392 - Deep endometriosis of the pelvic peritoneum, other specified sites
- N80.399 - Endometriosis of the pelvic peritoneum, other specified sites, unspecified depth
- N80.3B1 - Deep endometriosis of the right uterosacral ligament
- N80.3B2 - Deep endometriosis of the left uterosacral ligament
- N80.3B3 - Deep endometriosis of bilateral uterosacral ligament(s)
- N80.3B9 - Deep endometriosis of the uterosacral ligament(s), unspecified side
- N80.3C1 - Endometriosis of the right uterosacral ligament, unspecified depth
- N80.3C2 - Endometriosis of the left uterosacral ligament, unspecified depth
- N80.3C3 - Endometriosis of bilateral uterosacral ligament(s), unspecified depth
- N80.3C9 - Endometriosis of the uterosacral ligament(s), unspecified side, unspecified depth
- N80.512 - Deep endometriosis of the rectum
- N80.519 - Endometriosis of the rectum, unspecified depth
- N80.8 - Other endometriosis
- N80.9 - Endometriosis, unspecified
- N80.D0 - Endometriosis of the pelvic nerves, unspecified
- N80.D1 - Endometriosis of the sacral splanchnic nerves
- N80.D2 - Endometriosis of the sacral nerve roots
- N80.D3 - Endometriosis of the obturator nerve
- N80.D4 - Endometriosis of the sciatic nerve
- N80.D5 - Endometriosis of the pudendal nerve
- N80.D6 - Endometriosis of the femoral nerve
- N80.D9 - Endometriosis of other pelvic nerve
- N83.00 - Follicular cyst of ovary, unspecified side
- N83.01 - Follicular cyst of right ovary
- N83.02 - Follicular cyst of left ovary
- N83.10 - Corpus luteum cyst of ovary, unspecified side
- N83.11 - Corpus luteum cyst of right ovary
- N83.12 - Corpus luteum cyst of left ovary
- N83.201 - Unspecified ovarian cyst, right side
- N83.202 - Unspecified ovarian cyst, left side
- N83.209 - Unspecified ovarian cyst, unspecified side
- N83.291 - Other ovarian cyst, right side
- N83.292 - Other ovarian cyst, left side
- N83.299 - Other ovarian cyst, unspecified side
- N83.40 - Prolapse and hernia of ovary and fallopian tube, unspecified side
- N83.41 - Prolapse and hernia of right ovary and fallopian tube
- N83.42 - Prolapse and hernia of left ovary and fallopian tube
- N83.8 - Other noninflammatory disorders of ovary, fallopian tube and broad ligament
- N84.0 - Polyp of corpus uteri
- N84.1 - Polyp of cervix uteri
- N84.8 - Polyp of other parts of female genital tract
- N84.9 - Polyp of female genital tract, unspecified
- N85.00 - Endometrial hyperplasia, unspecified
- N85.01 - Benign endometrial hyperplasia
- N85.02 - Endometrial intraepithelial neoplasia [EIN]
- N85.A - Isthmocele
- N94.4 - Primary dysmenorrhea
- N94.5 - Secondary dysmenorrhea
- N94.6 - Dysmenorrhea, unspecified
- N94.89 - Other specified conditions associated with female genital organs and menstrual cycle
- N97.0 - Female infertility associated with anovulation
- N97.1 - Female infertility of tubal origin
- N97.2 - Female infertility of uterine origin
- N97.8 - Female infertility of other origin
- N99.83 - Residual ovary syndrome
- Q50.4 - Embryonic cyst of fallopian tube
- Q50.5 - Embryonic cyst of broad ligament
- T81.40XA - Infection following a procedure, unspecified, initial encounter
- T81.40XD - Infection following a procedure, unspecified, subsequent encounter
- T81.40XS - Infection following a procedure, unspecified, sequela
- Z80.44 - Family history of malignant neoplasm of fallopian tube(s)
Related CPT Codes to Keep on Hand
|
Code
| Description |
|
58660
| Laparoscopic lysis of adhesions (salpingolysis, ovariolysis) |
|
58661
| Laparoscopic removal of adnexal structures |
|
49320
| Diagnostic laparoscopy, with or without collection of washings |
|
49321
| Laparoscopy with biopsy |
|
58570 / 58571
| Laparoscopic total hysterectomy, by uterine weight |
Why This Code Trips Practices Up
Unlike hysterectomy codes, which vary by approach and uterine size, 58662 is a single "one size fits all" code covering everything from a handful of small implants to extensive multi-site disease. That flatness is exactly why documentation carries so much weight here, the code itself won't reflect the complexity of the case, so the operative note has to.
How RCM Matter Helps
Getting 58662 right takes more than knowing the code descriptor,it takes documentation review, correct modifier logic, and knowing which payers scrutinize this code most closely. RCM Matter provides medical coding services for California practices, including OB/GYN groups managing exactly this kind of laparoscopic surgical coding.
Our team helps practices:
- Distinguish billable therapeutic procedures from bundled or diagnostic-only services
- Apply modifiers based on payer-specific rules, not defaults
- Strengthen operative documentation before it becomes a denial
- Improve first-pass claim acceptance on complex GYN surgical coding
