General Surgery Coding Alert

Question: Can you please clarify correct coding for a Tru-Cut liver biopsy performed through the same opening at the same time as a laparoscopic cholecystectomy?

Kentucky Subscriber

Answer: The simplest answer may be to use 47379 (Unlisted laparoscopic procedure, liver), but some payers may say otherwise.

Understand procedure: Tru-Cut liver biopsy is a needle biopsy utilizing a special type of cutting needle comprised of an outer cannula with a serrated rod on the inside. The surgeon uses the interior rod to cut the tissue specimen, trap it inside the cannula, and withdraw the entire needle containing the specimen. The procedure is usually percutaneous, with or without imaging guidance. As such, the correct code for the procedure is 47000 (Biopsy of liver, needle; percutaneous) or +47001 (... when  done for indicated purpose at time of other major procedure [list separately in addition to code for primary procedure]).

CPT Assistant Dec. 2007 confirms these two codes for a liver biopsy performed under ultrasconic guidance (meaning that it is a percutaneous procedure). Percutaneous liver biopsy has become far more common than laparoscopic liver biopsy.

Laparoscopic biopsy: CPT does not provide a specific code for laparoscopic liver biopsy, but CPT Assistant Aug. 2006 indicates that the best code for the procedure is 47379 (Unlisted laparoscopic procedure, liver). CPT Assistant Dec. 2007 also states that you should use 47379 for a laparoscopic wedge liver biopsy performed in addition to a laparoscopic cholecystectomy (47562-47564, Laparoscopy, surgical; cholecystectomy ...)

Big question: Your question regards a gray area in which the surgeon performs a laparoscopic cholecystectomy and a Tru-Cut (needle) liver biopsy that is not percutaneous (instead, it is through the same opening at the same time as a lap cholecystectomy). This scenario does not exactly match the CPT Assistant example, which involves a lap chole and a wedge liver biopsy.

Answer: The simplest answer is that you should list a laparoscopic liver biopsy as 47379, regardless of how the surgeon takes the biopsy (needle or wedge). Payers may differ in their requirements for coding the Tru-Cut liver biopsy in addition to a lap chole, however. You may report either 47379 or +47001 in addition to the proper lap chole code, based on payer instruction.