# Liver biopsy (NOT percutaneous) @ time of lap chole



## trinalankford (Feb 19, 2013)

Skin incision is made in the midline just below the umbilicus, carried down through the peritoneum. A pursestring was placed around the fascial opening to be tied later. The disposable cannula was then placed in this wound. The abdomen was insufflated. The remaining 3 cannulae were placed. The patient was placed in slightly head elevated, left lateral decubitus position. Gallbladder was identified, grasped with a clamp, and traction applied laterally. Hartmann pouch was identified, grasped with a clamp, and traction applied laterally. This maneuver facilitated identification of the cystic duct and artery. Both were dissected out of the hepatoduodenal ligament onto the point of contact with the gallbladder. The cystic artery was ligated and transected. The cystic duct was then doubly ligated and transected. The gallbladder was taken off the bed using electrocautery with minimal bleeding and only a small amount of shed bile from the puncture wound. Incidentally noted was a 1 cm irregular nodule on the edge of the right lobe of the liver, suspicious for endometriosis. A second similar lesion was located nearby on omentum. The liver lesion was biosied with cup forceps. The abdomen was then irrigated copiously...

My question....This is not a percutaneous liver biopsy, so I can't use 47001, so what is my add-on code for this procedure? It was done with cup forceps.

Thank you!


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## diane1999 (Feb 20, 2013)

*liver bx*

47100 is what I would use.


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## diane1999 (Feb 20, 2013)

*liver bx*

47100 is what I would use.   forgot to say with  Modifier #59


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## MCook (Feb 21, 2013)

47100 is an open code and this is stated as occuring at the time of a lap chole. Also, what justification do you have to use Modifier 59?

SuperCoder has given this guidance below. I believe I have also seen it in CPT Assistant. 

There is a better choice: 49321 (Laparoscopy, surgical; with biopsy [single or multiple]). 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 are no bundling issues with 49321 and any of the laparoscopic cholecystectomy codes 47562-47564, so you should have no difficulty reporting both procedures (although multiple-procedure payment reductions will apply).


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## trinalankford (Feb 26, 2013)

Thank you very much!!


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## krowan (Apr 9, 2013)

*krowan RN, BSN CPC*

47001 is the needle liver bx done at the time of a major or primary procedure (requiring and incision thus making it an open liver bx not an percutaneous bX) Bx done with other primary procedures are add on procedures because they are easily done at the time of the other procedure, unlike a stand alone procedure:  the percutaneous one done straight throught the skin with x-ray or u/s as visual aide. Also it does not matter how the primary procedure is done  (open , Lap, robotic) the bx is still 47001 an add on to the primary. CPT say to use this code do not be confused by what 3M programs are calling open procedures this is refering to the liver bx itself not the primary procedure.


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