# Laparoscopic Liver biopsy



## drhoads

Physician performed a laparoscopic cholecystectomy, intraoperative cholangiogram, and liver biopsies X 4.  I am using cpt 47563 for lap chole but uncertain of the code for liver biopsies.  Any suggestions ????


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## hcg

drhoads said:


> Physician performed a laparoscopic cholecystectomy, intraoperative cholangiogram, and liver biopsies X 4.  I am using cpt 47563 for lap chole but uncertain of the code for liver biopsies.  Any suggestions ????



Have you tried code 47001?


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## drhoads

I did look at code 47001 but the liver bx were performed laparoscopic not during an open procedure.


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## hcg

drhoads said:


> I did look at code 47001 but the liver bx were performed laparoscopic not during an open procedure.




How about 47379? It is an unlisted laparoscopic procedure for liver.


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## drhoads

I was also looking at that code. I believe that is what I am left with using. Thank you very much!


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## hcg

drhoads said:


> I was also looking at that code. I believe that is what I am left with using. Thank you very much!



I had an argument on these codes with another coder. She said the best code would be 47001 since the code is an add on to major surgery. So Whether it be lap or open, if it is major surgery it still requires incision (close or open). But I still used 47379


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## MCook

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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## hcg

MCook said:


> 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).




Thank you so much for sharing the information. I also used this code for the procedure laparoscopic cholecystectomy with biopsy of peritoneal implant.


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## acf7575

*Laparoscopic cholecystectomy with Liver Biopsy or Peritoneal Biopsy*



MCook said:


> 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).



Since the original reply was from 2013, according to the NCCI (National Correct Coding Initiative) Practitioner PTP edit files, 49321 is a bundle with 47563 specifically my code I am using and has been since 10/01/2016.  A modifier is allowed to over-ride the "misuse of column two code with column one code" edit.  47562 and 47564 are also included in this bundle.  So, is it still acceptable when biling for a laparoscopic cholecystectomy (ex, 47562-47564) and a peritoneal implant biopsy or a liver biopsy with the 49321 XS modifier?  Does SuperCoder still support the 49321 or is it a bundled part and not separately billable?  
 Link to the NCCI edits:  https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html.


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## broncsrox

MCook said:


> 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).




CPT Assistant has several Q&A's stating to use 47379. They do not mention using 49321. I'm not sure of the date of the above referenced SuperCoder source but the Coding Alert link below also states to use 47379 and gives the reason why 49321 should not be used. Hope this is helpful. 

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


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