# Exploratory Laparoscopy concverted to open sm bowel resection



## skm510@live.com (Oct 16, 2012)

Surgery was started out as a exploratory laparoscopy then decision was made to convert to open with excisoin of small bowel.  Seeing as there was no surgical plan for excision prior to the exploration.  Can I safely use the 49320 with a mod -59 or -52 with the 44120? When I check in CCI edits it says they are allowed.  Just wondered what others are coding in these situations and if payments are being received.  I do realize if we started as a lap sm bowel resection and then converted to open I would bill the open with v64.41.


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## FTessaBartels (Oct 22, 2012)

*Separate Procedure*

Just so you are aware ... if a CPT code is defined as a *separate procedure*  (as is the case for 49320), then you will NOT have a CCI edit.  CCI assumes you already know that you can't code this unless it it a stand-alone (i.e. separate) procedure.


So you'll code ONLY for the 44120 and use the V64.41

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## AlaskanCoder (May 23, 2014)

You are correct about the CCI edit with a separate procedure.  However, there are exceptions when a "separate procedure" can be coded when other procedures are done in the same session. 
According to this article in CCI: http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/downloads/modifier59.pdf  it is appropriate to use modifier -59 under certain circumstances when a diagnositic procedure is done immediately prior to a therapeutic procedure.  If the surgery had stayed a laparoscopy, then definately only the surgical scope could be coded. But, I believe that in this instance it is appropriate to bill for both.


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