Summary & Overview
CPT 58822: Ovarian Abscess Drainage via Abdominal Incision
CPT code 58822 denotes the surgical drainage of an ovarian abscess through an abdominal incision. This procedure addresses a potentially serious gynecologic infection that can require operative management to control sepsis, preserve reproductive structures when possible, and reduce morbidity. Nationally, accurate coding for this operation matters for clinical tracking, appropriate billing, and alignment with surgical quality and infection-management metrics.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The discussion covers payer coverage considerations and common billing practices for operative pelvic procedures.
Readers will find a concise clinical context for the procedure, expected site-of-service settings, and an outline of common modifiers and payer interactions where available. The publication also summarizes benchmark topics and policy considerations relevant to billing and reimbursement for operative gynecologic drainage procedures, and highlights elements important for correct claim submission and clinical documentation. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 58822 describes a surgical procedure to drain an ovarian abscess via an abdominal incision. This procedure is a form of operative drainage of a pelvic abscess localized to the ovary and is performed by a surgical or gynecologic provider.
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Service type: Surgical drainage / operative procedure
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Typical site of service: Hospital operating room or ambulatory surgical center, performed under appropriate anesthesia
Clinical & Coding Specifications
Clinical Context
A typical patient is a woman of reproductive age or postmenopausal who presents to the emergency department or gynecology clinic with fever, lower abdominal pain, adnexal tenderness, and possible palpable mass. Imaging (transvaginal or transabdominal ultrasound, CT) demonstrates a complex adnexal collection consistent with an ovarian abscess or tubo-ovarian abscess that is refractory to or unsuitable for percutaneous or transvaginal drainage and intravenous antibiotics alone. The clinical workflow includes initial stabilization, sepsis screening, broad-spectrum IV antibiotics, imaging confirmation of abscess size and location, informed consent discussing operative risks and fertility implications, preoperative labs and anesthesia evaluation, and scheduling for operative drainage.
In the operating room under general anesthesia, the surgeon makes an abdominal incision (often a lower midline or Pfannenstiel incision depending on access needs), explores the pelvis, locates the ovarian abscess, evacuates purulent material, obtains cultures, performs irrigation and hemostasis, and places drains as indicated. Postoperative care includes continued IV antibiotics adjusted to culture results, pain control, wound care, follow-up imaging as clinically indicated, and outpatient gynecologic follow-up to monitor recovery and reproductive planning if relevant.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Use when no specific modifier applies to the service. |
22 | Increased procedural services | Use when work or complexity is substantially greater than typically required (document reasons for increased complexity such as dense adhesions or large multiloculated abscess). |
23 | Unusual anesthesia | Use when general anesthesia is medically contraindicated and substantially increased anesthesia is required for the procedure. |
26 | Professional component | Use when reporting only the professional component (rare for this global surgical procedure). |
50 | Bilateral procedure | Use when bilateral ovarian abscess drainage is performed and payer requires a bilateral modifier. |
51 | Multiple procedures | Use when other distinct procedures are performed during the same operative session (appendectomy, salpingectomy, etc.). |
52 | Reduced services | Use when the procedure is partially reduced or not completed as normally described (e.g., aborted due to unstable patient). |
53 | Discontinued procedure | Use when the procedure is terminated after initiation for reasons outside the provider's control (e.g., severe instability). |
59 | Distinct procedural service | Use when a separate, distinct procedure is performed at a separate site or session (e.g., concurrent diagnostic laparoscopy coded separately when payer requires distinction). |
62 | Two surgeons | Use when two surgeons from different specialties perform distinct parts of the procedure (e.g., gynecologic surgeon and general surgeon for bowel repair). |
66 | Surgical team | Use when a surgical team approach is necessary (complex multi-disciplinary case). |
78 | Return to OR for related procedure by same physician | Use when patient returns to the OR for a related procedure during the global period for complications. |
80 | Assistant surgeon | Use when an assistant surgeon participates and documentation supports their role. |
81 | Minimum assistant surgeon | Use when minimal assistance is provided and payer recognizes this modifier. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207V00000X | Obstetrics & Gynecology | Primary specialty performing ovarian abscess drainage. |
| 208D00000X | General Surgery | May be involved for complex abdominal access, adhesiolysis, or bowel involvement. |
| 363A00000X | Anesthesiology | Provides general anesthesia and perioperative management. |
| 207RH0000X | Reproductive Endocrinology | May be consulted for fertility-preserving planning when abscess affects reproductive organs. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
N70.91 | Unspecified acute pelvic inflammatory disease, unspecified female pelvic inflammatory disease | PID frequently leads to tubo-ovarian abscess formation requiring drainage. |
N70.1 | Acute salpingitis and oophoritis | Active adnexal infection that can progress to ovarian abscess. |
N83.3 | Unspecified ovarian cyst, hemorrhagic or inflammatory | Represents adnexal masses that may be infected and require drainage. |
N73.6 | Female pelvic inflammatory disorders in diseases classified elsewhere | Underlying systemic or local infections complicating pelvic organs and abscess formation. |
K65.0 | Acute peritonitis | Abscess rupture or generalized infection may cause or complicate peritonitis necessitating surgical drainage. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
58661 | Laparoscopy, surgical; with drainage of postoperative pelvic abscess (not routinely used for primary ovarian abscess drainage) | Minimally invasive alternative when transvaginal or percutaneous approaches are feasible; may be performed before or instead of open abdominal drainage. |
49000 | Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate procedure) | Performed when broader abdominal exploration is required beyond targeted ovarian abscess drainage. |
58670 | Laparoscopy, surgical, with lysis of adhesions (salpingostomy, salpingectomy not included) | May be performed concurrently if adhesions impede access to the abscess. |
49020 | Drainage of abscess; abdominal wall or subcutaneous (e.g., for superficial collections) | Used for superficial abdominal wall abscesses that may coexist or require separate drainage. |
36415 | Collection of venous blood by venipuncture | Common perioperative service for preoperative labs and cultures; typically performed during the same encounter. |