# Distal Pancreatectomy 48140- thoughts please



## kelsmith4471 (Aug 26, 2015)

I coded as 48999 (ref code 48140) and 47379 (ref code 47100)
It was rejected due to not enough documentation to support the 48140 distal pancreatectomy. Does the physician need to go into more detail via an addendem?



Laparoscopic distal pancreatectomy.
Laparoscopic left lateral segment wedge resection of liver mass.
INDICATIONS FOR SURGERY:
PRE-OPERATIVE DIAGNOSIS:
Distal pancreas mass and liver lesions.
POST-OPERATIVE DIAGNOSIS:
Distal pancreas mass and liver lesions.
ANESTHESIA:
SPECIMEN:
PROSTHETIC DEVICE/IMPLANT:
NARRATIVE:
The patient was taken to the operating room where she was prepped and draped in the standard surgical fashion in the supine position.  Through an infraumbilical Hasson cutdown technique, we entered the abdomen easily, insufflated and identified the lesion at the distal end of this tip of the pancreas tail after opening the lesser sac.  We used 2 upper midline 5 mm ports and 2 left lower quadrant 5 mm ports.  We mobilized the tail of the pancreas preserving the splenic vessels and resected the small portion of the tip of the tail of the spleen to encompass the pancreas mass 2.5 mm with tan cartridge Endo GIA stapler.  We observed approximately a dozen lesions on the surface of the liver, some which ranged in size from 2 cm to 3 mm.  We resected a 1 cm lesion on the left lateral segment of the liver through a wedge.  This was sent to Pathology for analysis.  We placed a Jackson-Pratt drain at the cut-end of the pancreas and brought it out through the left lower quadrant 5 mm port site.  The umbilicus was closed with 2-0 Vicryl stitches at the fascia and 4-0 Biosyn at the skin.  The patient tolerated the procedure very well and was taken to the recovery area in stable condition.


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## cynthiabrown (Aug 28, 2015)

What about equal to 48120   what does path say?


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## mzkandyd (Aug 30, 2015)

I too would want to see the path report on this as well.

I would compare your 48999 to 48120 because you DONT have enough documentation to support the 48140. The op note states 2.5mm, which means thats a small portion.

You should be ok if we rebill using 48999 comparing to 48120 AND 47379 compared to 47100.

In the event they reject your 48999 compared to 48120, appeal and highlight the 2.5cm to 3.5mm area in your op report. This supports the 48120 code.


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## codedog (Sep 19, 2015)

48999 seems ok to me


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