# Laparoscopic Cholecystectomy that turned to open Cholecystectomy



## mschrist3 (Feb 15, 2010)

I am from an Illinois ASC and we had a case recently that the Lap Chole had to be converted to open due to gallbladder inflammation.  The open Cholecystectomy is not on the approved procedure list-we billed the open and have been appealing.  My Physcian director thinks I should have billed the Lap Cholecystectomy as that was the intent and the procedure was 50% completed as Lap not open.  I disagree I say we must bill what the procedure actually was.  Does anyone have a good reference regarding coding of surgical procedures that have to converted during the surgical sessions.


----------



## emmaflattery (Feb 15, 2010)

*Lap Chole converted to open procedure*

Hi.  I would bill the lap chole as originally scheduled but also with the dx code "lap procedure converted to open".  I would also use modifier, I believe 58, as it is a related procedure and mail a copy of the operative report with the claim.  Hopefully this will help.  Good lock.
emma flattery


----------



## Chanda Wells (Feb 16, 2010)

Hello,

The response from eflatterycpc is incorrect.  You must bill the open procedure with the diagnoses code of laparascopic converted to open.  Once a procedure is converted to open you can not bill for the laparascopic portion.


----------



## emmaflattery (Feb 18, 2010)

I disagree.  If the doctor attempts a procedure but is stopped ,  he still performed a service which is y I said use a modifier.  Then bill the open with the convert to open code.  I just read a similar situation in the Medicare coding magazine.  Send your op note with the claim.
Thans
eflatterycpc


----------



## nc_coder (Feb 18, 2010)

*You should not bill the lap chole*

You bill the open chole with the original diagnosis for doing the surgery, the diagnosis of inflamed gallbladder, and the lap converted to open code V64.41.
This is the way I have always done it and when I took the exam for my General Surgery specialty credential, this was mentioned in the AAPC study guide for the exam.


----------



## Chanda Wells (Feb 18, 2010)

I agree with gscoder.  I worked in General Surgery for 5 1/2 years.  Billing the open chole has always been the appropriate way to bill in this situation.


----------



## gost (Feb 23, 2010)

eflatterycpc said:


> I disagree.  If the doctor attempts a procedure but is stopped ,  he still performed a service which is y I said use a modifier.  Then bill the open with the convert to open code.  I just read a similar situation in the Medicare coding magazine.  Send your op note with the claim.
> Thans
> eflatterycpc



You only billl the attempted procedure if it was discontinued and no further procedure was done.  (Bill with modifier -53).  If a laparoscopic procedure is converted to open you must bill the open procedure only and add dx V64.41.


----------



## bethh05 (Jul 15, 2011)

I know this is late but you code only for the open procedure, and use dx. V64.41. Here is an article with more info: www.fortherecordmag.com/archives/ftr_08212006p34.shtml


----------



## JJackson506 (Dec 10, 2011)

*A little late but the correct billing*

nc_coder is correct. You bill for what was performed, the open chole code with the original dx code, you have to identify medical necessity and then the convert to open code as your secondary dx code. You would never bill for both procedures, that is incorrect coding. Modifier -53 is only used if the procedure was not performed and no other procedure was performed.


----------



## QueensCoder (Dec 27, 2011)

*code the open proc*

When you have a lap procedure and converts to open. Code the open px.


----------



## stacyshults (Aug 12, 2014)

*Lap to open procedures*

What happens if one procedure is completed laparoscopically ie: splenetic flexure takedown, then the main procedure of sigmoidectomy is converted to open. Do you bill for the laparoscopic splenetic flexure then use V64.41 for the lap to open sigmoidectomy? Please advise!!!


----------



## emmaflattery (Aug 13, 2014)

I realize this is late but must say I was incorrect. If a procedure that started out laparoscopically and was converted to open, it should be billed as open with the dx of the procedure being done, and the lap converted to open dx.


----------

