# Hysterectomy - started laparscopic vaginal to total abdominal hysterectomy



## Lexes (Jan 23, 2018)

Wondering if someone has some advice for a case. The physician started with a Davinci assisted Vaginal Hysterectomy then ended up with an open laparotomy and total abdominal hyst. I would assume I can bill the 58552-53, and 58150. Dr. also stated open laparotomy as a procedure which I would assume is 49000. Will the 49000 be considered inclusive to the 58150?
Thank you.


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## thomas7331 (Jan 23, 2018)

Per NCCI guidelines, when a laparoscopic procedure is converted to an open procedure, only the open procedure is reported, so you would only code 58150.  From the NCCI Manual:  "_If a procedure utilizing one approach fails and is converted to a procedure utilizing a different approach, only the completed procedure may be reported. For example, if a laparoscopic hysterectomy is converted to an open hysterectomy, only the open hysterectomy procedure code may be reported.  If a laparoscopic procedure fails and is converted to an open procedure, the physician should not report a diagnostic laparoscopy in lieu of the failed laparoscopic procedure. For example, if a laparoscopic cholecystectomy is converted to an open cholecystectomy, the physician should not report the failed laparoscopic cholecystectomy nor a diagnostic laparoscopy_."

And yes, 49000 is inclusive and also cannot be reported - it is designated as a 'separate procedure' so is always inclusive to any other procedure at the same site or incision.


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## cgaston (Jan 24, 2018)

Think of it this way; the 49000 procedure is the physician opening up the abdomen and looking around.  EVERY open abdominal surgery begins with the physician opening up the abdomen and looking at the operating field.  That is why it is included.


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## Lexes (Jan 24, 2018)

thomas7331 said:


> Per NCCI guidelines, when a laparoscopic procedure is converted to an open procedure, only the open procedure is reported, so you would only code 58150.  From the NCCI Manual:  "_If a procedure utilizing one approach fails and is converted to a procedure utilizing a different approach, only the completed procedure may be reported. For example, if a laparoscopic hysterectomy is converted to an open hysterectomy, only the open hysterectomy procedure code may be reported.  If a laparoscopic procedure fails and is converted to an open procedure, the physician should not report a diagnostic laparoscopy in lieu of the failed laparoscopic procedure. For example, if a laparoscopic cholecystectomy is converted to an open cholecystectomy, the physician should not report the failed laparoscopic cholecystectomy nor a diagnostic laparoscopy_."
> 
> And yes, 49000 is inclusive and also cannot be reported - it is designated as a 'separate procedure' so is always inclusive to any other procedure at the same site or incision.



Thank you!


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