Summary & Overview
CPT 58960: Ovarian/Fallopian Tube/Peritoneal Cancer Staging with Lymphadenectomy
CPT code 58960 denotes a surgical staging procedure used to determine the extent of ovarian, fallopian tube, or primary peritoneal cancer by performing intra‑abdominal biopsies, pelvic lymph node removal, and para‑aortic lymph node sampling. This procedure is central to accurate cancer staging, which informs prognosis, chemotherapy planning, and potential need for further cytoreductive surgery. Nationally, consistent coding and documentation for 58960 affect case mix, quality measurement, and payment for gynecologic oncology services.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise overview of payer coverage considerations and common billing modifiers used with this procedure. Readers will gain clinical context about indications and typical sites of service, plus operational benchmarks and policy items relevant to hospital and ambulatory surgical settings. The report also summarizes documentation elements necessary to support coding and medical necessity determinations and highlights areas where payer policies and reimbursement practices most frequently affect claims for complex oncologic staging procedures.
Data not available in the input: specific associated taxonomies, ICD‑10 diagnoses, related codes, and granular payer reimbursement rates.
Billing Code Overview
CPT code 58960 describes a surgical staging procedure for ovarian, fallopian tube, or primary peritoneal cancer. The provider performs biopsies within the abdominal cavity, removes pelvic lymph nodes, and samples para‑aortic lymph nodes to determine the extent and stage of disease.
Service Type: Surgical staging and diagnostic laparoscopy/laparotomy with lymphadenectomy
Typical Site of Service: Hospital operating room or inpatient surgical unit, or ambulatory surgical center when clinically appropriate.
Clinical & Coding Specifications
Clinical Context
A 58-year-old woman presents with progressive abdominal distension, pelvic pain, and an adnexal mass identified on pelvic ultrasound. Tumor markers (CA-125) are elevated. The gynecologic oncology team schedules a diagnostic and staging procedure to determine the extent of suspected epithelial ovarian carcinoma. In the operating room under general anesthesia, the surgeon performs an exploratory laparotomy or minimally invasive laparoscopy to inspect the abdominal and pelvic cavities, obtain peritoneal washings, take multiple directed biopsies of suspicious lesions, perform bilateral pelvic lymphadenectomy, and sample para-aortic lymph nodes for pathologic staging. Intraoperative findings and frozen section pathology guide the extent of resection. Typical workflow includes preoperative imaging review, informed consent for staging and possible cytoreductive surgery, anesthesia evaluation, operative staging (peritoneal biopsies, pelvic lymph node removal and para‑aortic sampling), specimen labeling and submission to pathology, and postoperative recovery with inpatient monitoring. Typical site of service is an inpatient or outpatient hospital operating room or ambulatory surgery center depending on case complexity and anticipated procedures.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Procedure performed by the principal physician | Use when the primary surgeon performs the procedure without co-surgeon involvement |