# HELP! LAP converted to open--need coding advice



## Valerie813 (Sep 16, 2009)

My physician attempted a laproscopic supracervical hysterectomy.  He had to convert it to an open laparotomy with a supracervical hysterectomy.  What code(s) should I use to bill this???


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## Anna Weaver (Sep 16, 2009)

*conversion*



Valerie813 said:


> My physician attempted a laproscopic supracervical hysterectomy.  He had to convert it to an open laparotomy with a supracervical hysterectomy.  What code(s) should I use to bill this???



Look at 58180.


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## Valerie813 (Sep 16, 2009)

I think the 58180 would be appropriate for the hysterectomy, but should I also report the attempted LSH with a 53 for reduced services??


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## Anna Weaver (Sep 16, 2009)

*lap converted*

No, lap converted to open is coded with the open procedure only.
will look for the documentation.


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## Anna Weaver (Sep 16, 2009)

*conversion*

Here's the document from coding clinic. Don't forget your V64.4x diagnosis code

	Laparaoscopic procedure converted to open 
******Coding Clinic, Fourth Quarter 1997 Page: 52 Effective with discharges: October 1, 1997  
******Related Information 


Conversion of Laparoscopic Procedure 

Note from 3M:
 As of October 1, 2003 code V64.4 has been expanded to the fifth digit level to add additional closed surgical procedure approaches that were converted to open procedure; Laparoscopic (V64.41), Thoracoscopic (V64.42), and Arthroscopic (V64.43).

A new code has been created to document that, during the same operative procedure, a laparoscopic procedure has been converted to an open procedure. Since the first ICD-9-CM laparoscopic procedure code for cholecystectomy was introduced in 1991, more body sites are removed or repaired via laparascope. The laparoscopic approach is not always successful and sometimes it is necessary to convert the procedure to a more traditional open approach in order to perform the surgery. When a conversion is necessary, only the open procedure is coded. The new code V64.4, Laparoscopic surgical procedure converted to open procedure, is assigned as an additional code to provide further specification for data collection. If the conversion to open is due to a complication during the procedure, assign a code from the 997-999 range to describe the complication of surgical and medical care. 

Question: 

A patient is taken to the operating room for laparoscopic cholecystectomy for an acute and chronic cholecystitis. During the procedure, the surgeon decides that a laparoscopic approach is not safe because dissection was too difficult due to previous abdominal surgery scarring. An open cholecystectomy is then carried out uneventfully. What are the appropriate codes for this situation? 

Answer: 

Note from 3M:
 As of October 1, 2003, assign code V64.41, Laparoscopic surgical procedure coverted to open procedure.

Assign codes 575.12, Acute and chronic cholecystitis; V64.4, Laparoscopic surgical procedure converted to open procedure; and 51.22, Cholecystectomy. It is inappropriate to assign code 51.23, Laparoscopic cholecystectomy, since the definitive procedure was the open one. 

Question: 

A patient with a diagnosis of acute appendicitis undergoes a laparoscopy for attempted removal of appendix. However, due to severe hemorrhage complicating the procedure, a traditional appendectomy was performed. How should this be coded? 

Answer: 

Note from 3M:
 As of October 1, 2003, assign code V64.41, Laparoscopic surgical procedure coverted to open procedure.

Assign codes 540.9, Acute appendicitis, without mention of perforation; 998.11, Hemorrhage complicating a procedure; V64.4, Laparoscopic surgical procedure converted to open procedure; and 47.09, Other appendectomy. 




©*Copyright 1984-2009, American Hospital Association ("AHA"), Chicago, Illinois. Reproduced with permission. No portion of this publication may be copied without the express, written consent of AHA.


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## Valerie813 (Sep 16, 2009)

Thank you!!! You really helped me.


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## Lisa Bledsoe (Sep 16, 2009)

I am doing the AAPC COBGC practicum in preparation for the exam.  The practicum states three options:

Open procedure with modifier -22 (include V64.41)
Laparoscopic code with modifier -51 and -59 (include V64.41)
Laparoscopic code with modifier -52 (include V64.41)

Personally, I like the first option.  I don't see how any carrier will pay for the scope coded as well as the open procedure.


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