# Surgery help please



## cynthiaj54 (Sep 4, 2008)

I have a doctor wanting to bill a 58150 (Total abdominal Hyst) and a 49320 (Laparoscopy).  She went in to do a vag hyst but due to adhesions she converted to abdominal approach.  I am thinking she should bill only the 
58150.  Any oppinions?
thanks


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## Treetoad (Sep 4, 2008)

When converting from a laparoscopic procedure to an open procedure, you should only be charging the open procedure.


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## mbort (Sep 4, 2008)

I agree with Treetoad (that is the rule).  Be sure to use the appropriate V code for the lap convert to open


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## sbranham (Sep 4, 2008)

*Lap to Open*

I am in agreement with both ladies who chimed in before me. When converted to open... you can't bill the 49320, you should only bill 58150.


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## aguelfi (Sep 5, 2008)

In some surgeries, I bill the lap procedure w/ a mod 53 and then the open procedure w/ the v code for the conversion.  I get paid.


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## mbort (Sep 5, 2008)

sorry adrianne but I believe that is against correct coding.  Sounds like you may be coding for payment which is inappropriate.  Can you give an instance that you do this that could be appropriate?


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## mmelcam (Sep 5, 2008)

You would only bill the open procedure with the V diag code for lap converted to open


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## aguelfi (Sep 8, 2008)

*an example would be....*

Dr. initially started to perform a lap appy, after an extensive amount of time he realized he couldn't get to it w/ out causing more problems for the pt and at that point decided to discontinue the lap and convert to an open appy.
Can you show me something that states this would be inappropriate?


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## dmaec (Sep 8, 2008)

cynthiaj54,
I agree with the Treetoad, mbort, & sbranham -

Laparoscopic Procedures Converted to Open

There is currently no way to indicate, via code assignment, that a laparoscopic procedure has been converted to open. Some facilities are assigning both laparoscopic and open procedure codes when a conversion is done. *This is clearly an incorrect coding practice. **Coding rules dictate that if a procedure must be completed via an open approach, the laparoscopic approach is not coded. *Some facilities are using internally developed modifiers to identify laparoscopic procedures converted to open. It is recognized that facilities and epidemiologists need to be able to capture this information. There is currently no consensus regarding the best way to resolve this issue.
_{that's my opinion on the posted matter}_


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## mmelcam (Sep 8, 2008)

I am not sure if you subscribe to this but in the General Surgery Coder's Pink Sheet December 2007, Vol. 6, No. 12 issue there is a case file that states that only the open procedure can be billed. Hope this helps.


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## mbort (Sep 8, 2008)

Adrianne,

In the instance you mention, if your documentation supports it, you could use a modifier 22 on the open procedure, but billing both codes is unacceptable per the Correct Coding Initiative.  Please see the link:

http://www.cms.hhs.gov/NationalCorrectCodInitEd/

scroll down to the NCCI Medicare Part B, open it, you will probably have to unzip it, you will find it in almost every chapter, but specifically for the codes above in Chapter 6, page 6.

Hope this helps!
Mary


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## aguelfi (Sep 9, 2008)

Infortunately, I don't receive any of those publications.  I want to make sure that I'm doing it right, but somewhere in my past, I believe I've seen it written the way I do it, but it has to have certain documentation, not all cases would qualitify.  I know there's a copyright issue w/ the pink sheet but if you have anything else you could share or refer me to, please let me know.


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## mbort (Sep 9, 2008)

the correct coding initiative is free and available from Medicare in the link I provided in the previous post.


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## aguelfi (Sep 10, 2008)

thanks i really appreciate it...I'll take a look today.


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