# Modifier 52 or 53 - cholecystectomy



## dlk (Mar 24, 2009)

My surgeon discontinued a laparoscopic cholecystectomy due to extensive adhesions and the possibility of a CD stone and proceeded with a open procedure with and intraoperative cholangiogram.  What is the appropriate coding for this surgical procedure? In addition to the open cholecystectomy code, can I use the 52 modifier with the Lap code?  or should I use 53?  Thanks for your input!


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## Jarts (Mar 25, 2009)

Could you use 47605 as prime procedure and 49320 with mod 59 and dx: V64.41 as the secondary procedure? We have used this with success with several carriers.

Julie


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## FTessaBartels (Mar 25, 2009)

*Code only open procedure*

When you convert a lap procedure to an open procedure, you code ONLY the open procedure. Use V64.41 as a secondary dx.

F Tessa Bartels, CPC, CEMC


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## Jarts (Mar 25, 2009)

Tessa,
I cannot remember who advised us to bill our lap to opens this way, but If we are attaching the operative note to the claim when we are submitting with a second code of 49320-59 and they are paying on it, are we committing some type of fraud?

We obviously don't want to be doing something inappropriately but it seems odd the carriers would pay on this with all of our documentation if they did not feel it was appropriate. Just looking for some insight so we don't continue to code this way if it's definitely a no no.

Thanks, 
Julie


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## iluvicd9 (Mar 26, 2009)

*Lap to Open*

If the physician converts from a lap procedure to an open procedure, you should only code for the open procedure.


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## dmaec (Mar 26, 2009)

it's fraud when you KNOWINGLY code incorrectly (getting paid for something that is knowingly wrong)..

so, now - IF you continue to do it, (knowing it is wrong)...it becomes FRAUD.

gather your info on it.  When converting from lap to open, you code only the open. Don't be attaching the .59 to the lap procedure.. code only the open.


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## Jarts (Mar 26, 2009)

Thanks for the confirmation, Sandy and Donna


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