# Laparoscopic surgery converted to Open surgery



## pvang (May 12, 2010)

Hi-

When a procedure that was planned as a laparoscopic surgery has to be converted to an open surgery, can they bill both the original surgical code 
(58553- Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g) and the procedure that was actually done (58150- Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s))? In this instance, mod -53 is appended to 58553. Does this modifier make billing these two pairs appropriate? Thanks. 

-Pa Tang


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## RebeccaWoodward* (May 12, 2010)

If a laparoscopic procedure is converted to an open procedure, only the open procedure may be reported.

http://www.cms.gov/NationalCorrectCodInitEd/01_overview.asp

Select NCCI Policy Manual link and open chapter 7-page 10


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## ASH527 (May 12, 2010)

I agree you can only bill the open procedure - and also use diagnosis code 
v64.41


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## pvang (May 12, 2010)

Thanks to you both for your reply. I vaguely remembered from somewhere (maybe while I was still going to school for this) that only the open procedure be coded, but I wasn't able to find any thing about it on paper. Thanks for the link.


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## pvang (Jun 15, 2010)

*AMA Coding Guidelines?*

Hi- 

I know I posted this question awhile ago, but I was wondering if anyone has any documentation or know what AMA's guideline is currently on this issue? I have some documentation (but it's from 2009) about how AMA allows both the open and the converted laparoscopic surgery to be coded and paid. I would like to know if anyone has access to find out AMA's _current_ guideline on this matter. Thanks for the help!

-Pa Tang


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## tinawilliams (May 21, 2013)

Hello Pa Tang,

I agree, with you that it is possible to report both if well documented. It was in a CMS ruling, because if the significant resources were applied to laparoscopic procedure that the laparoscopic procedure was billable with the open. However, locating the ruling is difficult.


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## AlaskanCoder (May 23, 2014)

I have a question: what if there was a planned diagnositc laparoscopy and a planned open surgical lap?  
In this article from CMS and the CCI, it states that it is appropriate to use modifier -59 if the the diagnostic procedure immediately precedes the surgical or non-surgical therapeutic procedure and it clearly provides the information needed to decide to continue with the therapeutic procedure and does not constitute services that would be included in the therapeutic procedure.  http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/downloads/modifier59.pdf

I have a patient with a known history of hep-c infection who has a new lesion on his right hepatic lobe immediately adjacent to the inferior vena cava. After examining the liver and confirming the location of the mass and the vnous and arterial flows in the liver via laparoscope, the surgeon performed a laparotomy due to the location of the lesion, the patient's body habitus and a desire to minimize the duration of anesthetic. 

Given this information, what are your views on billing for a diagnostic laparscope and the open lobectomy?

Thank you for any opinions.

I think I just found the answer to my question in the CCI manual Chapter 1.C.12  My only problem now is, what is the difference between a scope being the basis for the open procedure and the scope being a scout procedure?


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