General Surgery Coding Alert

Question: How should we bill for a laparoscopic excision and closure of a colovesical fistula with two surgeons? Our surgeon performed the bladder side of the procedure, excising bladder tissue due to localized necrosis, followed by two-layer closure. Our surgeon then instilled saline to check for evidence of leaks.

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Answer: Because there is not code for doing this procedure laparoscopically, you should report the service as 44238 (Unlisted laparoscopy procedure, intestine [except rectum]).

Although you indicate that the procedure involved two surgeons, you should not try to use modifier 62 (Two surgeons), because most payers don’t want pricing modifiers such as 62 on unlisted procedure codes.

Do this: Because you need to indicate the price for an unlisted code, you should price the procedure as though you used modifier 62. That means setting the value at 125 percent of 44661 (Closure of enterovesical fistula; with intestine and/or bladder resection) times 62.5 percent for your surgeon’s work on the bladder side.