# Laparoscopic liver biopsy - Anyone have any idea



## Leanne

Anyone have any idea on how to code a laparoscopic liver biopsy (0.5cm liver lesion excised) done during lap colectomy?


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## mbort

see if 47001 will work for you


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## Leanne

Thanks.  I looked at that one but Coder's Desk Reference says to report 47001 when liver biopsy is performed during an open procedure.  Since it was done during a laparoscopic colectomy I didn't think it would apply.


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## mbort

since the 47001 is an add on procedure, I did double check the "primary procedure list" and lap colectomies are listed.  So in short, yes the 47001 could be used with it.

please see below:

Primary Px - 47001 
*This list shows the primary procedure codes(s) appropriate for use with this add-on code.  * 

44146  Colectomy, partial; with coloproctostomy (low pelvic anastomosis), with colostomy  
44147  Colectomy, partial; abdominal and transanal approach  
44150  Colectomy, total, abdominal, without proctectomy; with ileostomy or ileoproctostomy  
44151  Colectomy, total, abdominal, without proctectomy; with continent ileostomy  
44155  Colectomy, total, abdominal, with proctectomy; with ileostomy  
44156  Colectomy, total, abdominal, with proctectomy; with continent ileostomy  
44160  Colectomy, partial, with removal of terminal ileum with ileocolostomy  
44204  Laparoscopy, surgical; colectomy, partial, with anastomosis  
44205  Laparoscopy, surgical; colectomy, partial, with removal of terminal ileum with ileocolostomy  
44206  Laparoscopy, surgical; colectomy, partial, with end colostomy and closure of distal segment (Hartmann type procedure)  
44207  Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis)  
44208  Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis) with colostomy  
44210  Laparoscopy, surgical; colectomy, total, abdominal, without proctectomy, with ileostomy or ileoproctostomy  
44211  Laparoscopy, surgical; colectomy, total, abdominal, with proctectomy, with ileoanal anastomosis, creation of ileal reservoir (S or J), with loop ileostomy, includes rectal mucosectomy, when performed  
44212  Laparoscopy, surgical; colectomy, total, abdominal, with proctectomy, with ileostomy  
44300  Placement, enterostomy or cecostomy, tube open (eg, for feeding or decompression) (separate procedure)  
44310  Ileostomy or jejunostomy, non-tube   
 (That is only a partial list as its way too long to put here)


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## Treetoad

You'd need to use unlisted procedure 47379.


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## mbort

I would not recommend using an unlisted code unless the 47001 does not meet the documentation guidelines of the biopsy.


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## Robin R

I just read an article in the General Surgery Coding Alert that says to use 49321 (2008, Vol 10, No 4, page 30).  It says "Although this code does not specify "liver," it falls under the general "laparoscopy" portion of CPT and clearly describes the procedure your surgeon performed.  As CPT guidelines specify, you can (and should) save yourself the hassles of reporting an unlisted-procedure code unless "no specific code exists" to describe the procedure you wish to report."


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## PIGGYPAIGE

47379 is the code we always use for lap liver wedge biopsies.  Just remember to let them know what you are using this code for and send notes.


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## Treetoad

I believe procedure code 47001 to be an open procedure.


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## bmcduo2

Robin M said:


> I just read an article in the General Surgery Coding Alert that says to use 49321 (2008, Vol 10, No 4, page 30).  It says "Although this code does not specify "liver," it falls under the general "laparoscopy" portion of CPT and clearly describes the procedure your surgeon performed.  As CPT guidelines specify, you can (and should) save yourself the hassles of reporting an unlisted-procedure code unless "no specific code exists" to describe the procedure you wish to report."


There was an update to this just issued in the August General Surgery Coding Alert (2008, Vol 10, No 11, page 86), that now recommends that the unlisted CPT 47379 be used for laparoscopic liver biopsies.


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## mbort

I prefer to go by AMA guidelines and documentation so I will stand by my previous post with the documentation that supports that the add on code 47001 can be used with the laproscopic CPT that was in the original post


*Primary Px - 47001 *
*This list shows the primary procedure codes(s) appropriate for use with this add-on code. *
44146 Colectomy, partial; with coloproctostomy (low pelvic anastomosis), with colostomy 
44147 Colectomy, partial; abdominal and transanal approach 
44150 Colectomy, total, abdominal, without proctectomy; with ileostomy or ileoproctostomy 
44151 Colectomy, total, abdominal, without proctectomy; with continent ileostomy 
44155 Colectomy, total, abdominal, with proctectomy; with ileostomy 
44156 Colectomy, total, abdominal, with proctectomy; with continent ileostomy 
44160 Colectomy, partial, with removal of terminal ileum with ileocolostomy 
44204 Laparoscopy, surgical; colectomy, partial, with anastomosis 
44205 Laparoscopy, surgical; colectomy, partial, with removal of terminal ileum with ileocolostomy 
44206 Laparoscopy, surgical; colectomy, partial, with end colostomy and closure of distal segment (Hartmann type procedure) 
44207 Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis) 
44208 Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis) with colostomy 
44210 Laparoscopy, surgical; colectomy, total, abdominal, without proctectomy, with ileostomy or ileoproctostomy 
44211 Laparoscopy, surgical; colectomy, total, abdominal, with proctectomy, with ileoanal anastomosis, creation of ileal reservoir (S or J), with loop ileostomy, includes rectal mucosectomy, when performed 
44212 Laparoscopy, surgical; colectomy, total, abdominal, with proctectomy, with ileostomy 
44300 Placement, enterostomy or cecostomy, tube open (eg, for feeding or decompression) (separate procedure) 
44310 Ileostomy or jejunostomy, non-tube 
(That is only a partial list as its way too long to put here)


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## bmcduo2

As an add-on, I agree with Cpt 47001. I was just providing a response to Robin's 7-11-08 post, and a more recent update found on coding of separate lap liver biopsies.

Apologize for any confusion.


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## mony94803

I agree, 47379 is used according to General Surgery


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## krowan

the 47001 is correct as it is being done at the time of a major procedure. Don't confuse open to mean which way the major procedure is being done ie. open vs Lap. Open in this case means how the needle biopsy was done percutaneous (closed) or open in which an incision would have been used any
major procedure requires a incision where laproscopic or open belly. But open for the liver bx is strickly how it was done open or closed has nothing to do with the way the major procedure was done.


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## Leanne

Thanks for all of the responses!  Just noticed this thread has had over 11,000 views!!!  I guess I wasn't the only confused by this.   But the most recent response explains it perfectly, I hadn't thought of the liver biopsy itself being an open procedure.  That makes sense!  Thanks again for everyone's input!


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