# liver wedge resection



## Callieb (Jun 16, 2016)

I'm not sure which would be best way to bill this. Dr did diagnostic laparoscopy with wedge resection of liver lesion which was sent for path confirming metastatic ca.  He then converted to open procedure and did a partial gastrectomy.  My question is which would be best, an unlisted laparoscopic code 47379 or exploratory laparoscopy with biopsy 49321?  I'm leaning towards the unlisted code but those can be difficult to bill some times.  Patient has private bcbs.


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## cgaston (Jun 16, 2016)

I found this out on the web:
_
*Q* Can you ever bill for laparoscopy and an open surgery during the same encounter?


*A* You can report a laparoscopic procedure at the same encounter as an open procedure if the
endoscopic procedure represents a distinct diagnostic service prior to an open surgical procedure.

Also, the decision to perform the open procedure must be made based on the diagnostic endoscopy.
In this situation, use the -58 modifier.
_

If the laparoscopic wedge resection led to the decision to perform the open gastrectomy you should be able to bill for both as long as the notes state that the decision for the gastrectomy was made due to the biopsy results. 

At least that is how I see it, anyway.


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## Callieb (Jun 16, 2016)

thanks, seems the best to do, i just hate billing unlisted lap codes but sometimes can't be helped.


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## michellepilcher (Jun 16, 2016)

When coding the laparoscopic liver bx we use the 47379 and reference the code 47100 (open).

http://http://hcnewsletters.com/pdfs/gcav13n12.pdf

49321: Stick to Anatomic Site for Code Selection
Question:
Can we use 49321 for a laparoscopic liver biopsy to avoid using an “unlisted” code? 
Tennessee Subscriber

Answer:
No, you should not report a laparoscopic liver biopsy using 49321 (Laparoscopy, surgical; with biopsy [single or multiple]). Instead, you should report the service using 47379 (Unlisted laparoscopic procedure, liver). 

Here’s why:
49321 is in the CPT subsection for “Abdomen, peritoneum, and omentum” (49000-49999). Because CPT provides specific codes in the “Liver” subsection (47000-47399), you should use one of those codes for a 
liver procedure. Because CPT® doesn’t provide a specific laparoscopic liver biopsy code, you need to choose the unlisted procedure code. 
Furthermore:The AMA has weighed in on this coding question in two CPT Assistant references. 
CPT Assistant Aug. 2006 indicates that the best code for the procedure is 47379, while Dec. 2007 also states that you should use 47379 for a laparoscopic wedge liver biopsy performed in addition to a aparoscopic cholecystectomy (47562-47564,Laparoscopy, surgical; cholecystectomy ...).You should find no advantage in avoiding “unlisted” codes. Sometimes, those are the best code to describe a service, and you should use them unless a specific payer requires a different 
code for a particular procedure. 

I send that HCN newsletter with the OP note and it's always been paid.  Hope that helps!


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