General Surgery Coding Alert

Question: If a surgeon does multiple partial liver lobectomies would you use the 47120 more than once? For example, our surgeon documents a partial right hepatic lobectomy (excision of segment 8), a second partial right hepatic lobectomy (excision of segment 5), and a partial left hepatic lobectomy (excision of segment 4). Should we code 47120 x 3, or 47120-RT x 2 plus 47120-LT-51, or 47120-RT plus 47120-RT-51-59 plus 47120-LT-51-59?

Illinois Subscriber

Answer: You should not report multiple units of 47120 (Hepatectomy, resection of liver; partial lobectomy), with or without modifiers LT (Left side), RT (Right side), 51(Multiple procedures),or 59 (Distinct procedural service).

The procedure you describe better fits code 47122 (Hepatectomy, resection of liver; trisegmentectomy).

In right hepatic trisegmentectomy, the surgeon removes some or all of the right hepatic lobe plus a medial segment of the left lobe. This fits the description of the procedure your surgeon performed. You might also see a left trisegmentectomy, which involves the left lobe plus anterior or posterior segment of the right lobe.

Reason: Surgeons sometimes perform atrisegmentectomy for hepatobiliary malignancies and diffuse liver metastasis. The procedure can increase the odds of accomplishing a resection with negative margins.