# Hand assisted lap right colectomy



## vkratzer (Mar 30, 2009)

Can I code a laparotomy (49000) for the hand assisted part of the colectomy as well as 44204?  Or is there another code I should be using?

Thanks for your help.

Vicky


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## aguelfi (Apr 1, 2009)

Unless he converted to an open procedure you would use 44204 and possibly 44213 if he took down the slpenic flexure.   49000 is for Exploratory laparotomy (open) and you are describing 2 different types of entry.  Once it's converted from a laparscopic repair to an open repair, you would use the open procedure code (44140) w/ V64.41 as the dx.


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## luz.buenaventura (Apr 1, 2009)

Surgical laparoscopy includes exploratory laparoscopy which is not separately reportable. It would have been a different scenario if the exploratory laparoscopy leads to the performance of a NON - laparoscopic surgical procedure, then it may be separately reportable with a modifier 58. The medical record must indicate the medical necessity for the exploratory laparoscopy.


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## cmrccs (Aug 13, 2010)

Are surgical coders coding laparoscopic hand-assisted procedures as laparoscopic or open?  There seems to be some conflicting information out there.


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## preserene (Aug 13, 2010)

Unless he converted to an open procedure you would use 44204 and possibly 44213 if he took down the slpenic flexure. 49000 is for Exploratory laparotomy (open) and you are describing 2 different types of entry. Once it's converted from a laparscopic repair to an open repair, you would use the open procedure code (44140) w/ V64.41 as the dx. 
__________________
adrianne, cpc 

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Last edited by abenson; 04-01-2009 at 05:34 AM. 

Question:Are surgical coders coding laparoscopic hand-assisted procedures as laparoscopic or open? There seems to be some conflicting information out there.  
04-01-2009 06:06 AM 
 I like the first quote it gives good  basic info I needed Thank you Abenson!. 

The 2nd quote  I like that. Thank you very much for digging out and bring it to the surface . Great job you did. Thank you, cmrccs

 This is a great topic involving multi specialties.

Well Abenson, it V64.4x holds good for surgical laprocsopic,  thorocoscopic, arthroscopic surgical procedures converted to open procedures. 

Here I go with my quieries:

1. so V64.41 holds good for gyne procedures also?  If not which one then?

2. If so would you not add up the CPT code 44140 +44139 when you take down mobilization while doing Hartmanns Colectomy  hand assisted?

3.and while so and while combining the colovaginal or rectovaginal fistula repair along with Hartmanns with hand assisted and like MINILAPOROTOMY procedure, what is wrong in assigning an open approach procedure for RVF OR CVF repair - the code * 57307* which is also a major but separate procedure.
Or, are we to be contented with appending  a rescuing modifier alone?
 I know it is complex but I need to know when a Surgeon does all these , we need to to be very appropriate in assignment of codes. leave alone the basic concern of money and we playing the 'puppets' in the hands of payers. Right?!!


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