General Surgery Coding Alert

Question: What is the proper coding for an endoscopic Lintons operation (subfascial ligation of incompetent perforators)?

Anonymous Subscriber OH

Answer: There is no code as yet for an endoscopic Linton procedure, so the open procedure code, (37760, ligation of perforators, subfascial, radical [Linton type], with or without skin graft]) should be used with a -22 modifier (unusual procedural services) attached. This claim should be accompanied by an operative report and a cover letter from the surgeon that describes why the procedure was performed. This is a new procedure, and not all physicians are trained to do it and not all hospitals have the equipment for it. So the letter from the physician should indicate that the procedure required a high level of expertise, which would justify using the -22 modifier.

Some carriers may prefer that, the surgeon should use an unlisted code, in this case 37799 (unlisted procedure). Nancy Witts, a coder with a large multispecialty practice in Arizona, says that some carriers in her area sometimes prefer the use of unlisted codes for laparoscopic procedures. One thing weve had to use unlisted codes for is a laparoscopic Burch. Although the code for an open Burch is 51840 (anterior vesicourethropexy, or urethropexy [e.g., Marshall-Marchetti-Krantz, Burch]; simple), North Dakota Blue Cross Blue Shield wants us to use an unlisted laparoscopic procedure. So when youre talking about taking care of perforators, I would probably use the unlisted code. Sometimes when you cant find any thing else, you use similar guidelines for other procedures, Witts says.

It is likely that as the endoscopic Linton procedure becomes more widespread, a new CPT code will be created for it. In the meantime, make sure you check with your carrier before billing the procedure.