# discontinued procedure - Diagnostic laparoscopy



## lindacoder (May 28, 2013)

Scheduled as a laparoscopic cholecystectomy. Would you bill 47562 with 53 modifier or just 49320?


  PREOPERATIVE DIAGNOSIS:  Cholelithiasis.

POSTOPERATIVE DIAGNOSIS:  Severe macronodular cirrhosis with ascites.

PROCEDURES PERFORMED:  Diagnostic laparoscopy.

SURGEON:  Counseling MD

ANESTHESIA:  General.

PATHOLOGY SPECIMEN SENT:  None.

ESTIMATED BLOOD LOSS:  50 mL.

DESCRIPTION OF SURGERY:  The patient was brought to the operating room and  general anesthesia induced.  The abdomen was sterilely prepped and draped in  usual fashion.  The abdomen was entered through a small incision below the  umbilicus using the Optiview port site technique.  A good pneumoperitoneum at  15 mmHg was obtained without difficulty.  Laparoscope was inserted.  There was  no evidence of any intraabdominal injury from the trocar insertion.  Under  direct visualization, a 12 mm trocar was then placed to the right of the  patient's falciform ligament followed by two 5 mm trocars along the  midclavicular anterior axillary lines.  The patient was then placed in a steep  reverse Trendelenburg position.  Of note, the liver was diffusely macular  nodular in appearance.  There was evidence of cirrhosis in the perihepatic  spaces.  The gallbladder did have some omentum sucked about it, this was taken  down with Harmonic; however, on manipulation of the gallbladder there was  probably a 50 mL bleed from the liver bed with just simply grasping the  gallbladder.  Therefore, due to the severe liver disease and obvious  friability of the liver bed from this the procedure was aborted.  Therefore,  the patient was placed back in supine position.  The pneumoperitoneum was  released and trocars were removed.  The patient was then awakened from  anesthesia, extubated and transferred to the recovery room in stable  condition.


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## jplouffe (May 28, 2013)

I would only code for the laparoscopy.


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## GaPeach77 (May 28, 2013)

Because the surgeon documented that the procedure was aborted and stated the reason why, I would  code the procedure with the modifier 53 for reduced services since the documentation supports the use of the modifier resulting in a higher RVU then just the lap.


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