# Code a Laparoscopic Pyloromyotomy with open code and modifier 22 ????



## amaust (Feb 14, 2018)

My doctor is a pediatric surgeon who gets reimbursed based on RVU's.  He does numerous laparoscopic pyloromytomies which I code using the unlisted laparoscopic code of stomach 43659, because there is not a code for the laparoscopic approach.  The unlisted code carries no RVU's, and he has asked me if I would be able to start coding the laparoscopic procedure with the open code of 43520 with a modifier 22.  I'm not sure that is correct, so I am reaching out for some feedback and advice.  
Thanks,
Annette


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## mitchellde (Feb 14, 2018)

Nothing official here but here goes... I was instructed years ago by a person of questionable education that you use the open code with a 52 modifier for a reduction since you did not make a full open incision.  However after speaking with many different surgeons in many different specialties I learned that the laparoscopic approach, while seemingly better for patient recovery is way more difficult for the provider so it was thought given the physician perspective that using the open code with the 22 modifier is a more accurate picture of the provider time and effort involved.  Therefore I see no problem with coding it this way and I could provide logic to the payer to justify this if I was pushed to need to do so.


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