General Surgery Coding Alert

Question: How should we report the procedure when our surgeon performs laparoscopic closure of two intestinal fistulae?

Nevada Subscriber

Answer: You should report two units of 44238 (Unlisted laparoscopy procedure, intestine [except rectum]). You can generally report 44238x2, although some payers may prefer that you report each code on a separate claim line and list the second procedure with modifier 59 (Distinct procedural service).

Although CPT provides a specific code for intestinal fistula closure, you can’t use it, because it describes an open procedure and you specified that the surgeon performed a laparoscopic procedure. The open code is 44650 (Closure of enteroenteric or enterocolic fistula).

Pricing help: Because you’re billing a code for an unlisted procedure, you can compare and benchmark 44238 to the open code for the same procedure — 44650 — when submitting your charges.