General Surgery Coding Alert

Question: A surgeon in our practice performed a laparoscopic cholecystectomy. Although the “procedure” statement in the op report simply states “laparoscopic cholecys­tectomy,” the body of the report also documents a radiological examination of bile ducts, as well as exploration and removal of gallstones from the common duct. How should I code this procedure?

New York Subscriber

Answer: The correct code is 47564 (Laparoscopy, surgical; cholecystectomy with exploration of common duct).

Avoid: Although your surgeon documented that the lap chol included both a cholangiography and exploration of the common duct to remove gallstones, you should report just the most extensive procedure (47564). You should not additionally report the code for the cholecystectomy plus cholangiography (47563, Laparoscopy, surgical; cholecystectomy with cholangiography). In fact, the Correct Coding Initiative (CCI) bundles 47563 and 47564 with a modifier indicator of “0,” meaning that you can’t report the two codes together under any circumstances.

Code from body of report: For the example you give, you should not code from the “procedure” statement in the report, because it leaves out other work that the surgeon documents in the body of the report. If you reported just the laparoscopic cholecystectomy, you would list 47562 (Laparoscopy, surgical; cholecystectomy), which pays $473.33 less than 47564 (Medicare Physician Fee Schedule national facility amounts, conversion factor 35.8043).

Problem: Many surgeons perform cholangiography (radiologic examination of the bile ducts) as a standard component of cholecystectomy. Because the surgeon considers the cholangiography routine, he or she may fail to note the procedure in the operative report summary. That’s why you need to read carefully through the entire report and choose the most specific code based on the complete documentation.