General Surgery Coding Alert

Question: For a patient with abdominal lymphadenopathy, our surgeon performed a laparoscopic lymphadenectomy, removing several mesenteric nodes from the right lower abdominal quadrant. The procedure involved two ports, one through an incisional hernia from a prior surgery. Following the lymph node removal, the patient exhibited intraabdominal bleeding that led the surgeon to perform a laparotomy, connecting the port wounds and extending above the umbilicus, The surgeon controlled the bleeding, then repaired the incisional port hernia and closed the surgical site. Can we separately report the laparoscopic lymphadenectomy, the laparotomy, and the hernia repair? Virginia SubscriberAnswer: No, you should not code three separate procedures (laparoscopic mesenteric lymph node biopsy, laparotomy with bleeding control, and incisional hernia repair). You should treat the service as a laparoscopic procedure converted to an open procedure, and report only the most extensive (open) code. CPT® provides many specific lymphadenectomy codes for superficial and deep nodes from [...]