# Mini Lap



## MarineMom1 (Dec 21, 2010)

Merry Christmas all,

I need some help please- does anyone know how to code a mini lap with excision of abd wall mass?

Thanks in advance for your help!
Marine Mom


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## preserene (Dec 21, 2010)

Since no one has come forward so far, I just post this for some kind of info I know; take  if you find it useful.

Minilaparotomy:
A small incision on the lower abdomen above the level of symphysis pubis for performing surgical ligation of the fallopian tubes, liver biopsy, open transhepatic cholangiography, or sterilization by ovariectomy or some more surgeries in the pelvic cavity.

'MINILAP' is a 'suprapubic appraoch' of opening the abdomen. It is a safe time saving and an easier procedure than the conventional abdominal approach.
It is mainly used for gynecological surgeries and it had its great time in 1960s - 2000 and dearly called as female tubal sterilization Minilaparotomy because it was prevalent procedure for camp female sterilization with great potentials in developing countries.
To mention some more are : Abdominal Aortic Aneurysm Repair, Abdominal Aortic Aneurysm Repair, Ultra-Minilaparotomy Myomectomy, myomectomy, ovarian surgeries, ‘Tubal Reversal Blog ‘mini laparotomy’
IVF vs. Tubal Ligation Reversal Mini laparotomy’, and so on.

*I believe that it is reasonable to assign the primary CPT code for the procedure ( open) . 

If laparoscopic assisted with mini, then I feel justified to append with modifier -22. There again if it is a small incision within the required ones for minilap , this could hold good.
Otherwise , if it involves,
 an extended incision similar to original laparotomy, (or say like those for open abdominal hysterectomy, or open cesarean incision) then I think the laparoscopic will no longer be reported but only the open major abdominal primary procedure code would justify*


Now adays,  Minilap  is considered as a ‘Minimally Invasive Alternative for Major Gynecologic Abdominal Surgery’.  Physicians are beginning to adopt minilaparotomy hysterectomy because it is far easier to teach than vaginal or laparoscopic hysterectomy and produces excellent results. The procedure may also be useful in urologic practice (eg, for pelvic node dissection) and in some general surgery procedures. Nonetheless, despite the utility of having this minimally invasive approach in our surgical repertoire, we must continue to use more conservative alternatives to hysterectomy, such as "watchful waiting," medical therapy, and endometrial ablation. 
So procedural wise, it merits all that it deserves for any open primary procedure of its kind. Hence it is justified to code so, as long as we do not have separate code  for Minilap.
 Believe me,some times, the amount of stress and the efforts the physicians take to perform, is not easier than the original open procedures within the narrow space, but for the reduction in patient stay in the hospital and cost effectiveness.   

Until we get new code for mini, I think it is reasonable to code with the primary procedural one for that particular procedure.

But you better wait for other expert coder's opinion.
Wish you a merry Christmas and a happy & bright New Year too!


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## MarineMom1 (Dec 22, 2010)

thanks for the info!


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