General Surgery Coding Alert

Question: Our surgeon performed a laparoscopic cholecystectomy with an attempted intraoperative cholan-giogram. The cholangiogram failed, however, because the catheter did not pass through. Should I report 47562 with modifier -22, or should I bill 47563 because the surgeon completed 90 percent of the procedure?

Minnesota Subscriber

Answer: The answer depends primarily on the strength of the surgeon's documentation.

To begin, you should definitely not choose 47563 (Laparoscopy, surgical; cholecystectomy with cholangiography). That the surgeon completed "90 percent" of the work described by the code is not sufficient: The surgeon must perform the total service before you may report a given CPT code, which has not happened in this case.

Because the surgeon attempted (but failed to complete) the cholangiography, you could report 47563 with modifier -52 (Reduced services) appended.

Your accompanying documentation should make clear that the surgeon planned and attempted the cholangiography, but only completed the colecystectomy.

A second -- and perhaps better -- choice would be to report 47562 (Laparoscopy, surgical; cholecystectomy), either with or without modifier -22 (Unusual procedural services), depending on how well the surgeon documented his efforts. As a general guideline, the surgeon should have spent at least an additional 25 percent more time or effort (which he must note specifically in the operative report) before you append modifier -22.

In this case, if the surgeon can prove that he expended significant additional effort on the failed cholangiography, report 47562 with modifier -22. Include a cover letter with the claim explaining the extenuating circumstances of the surgery and request additional compensation for the effort.

If the surgeon did not carefully and completely document his efforts, however, you cannot append modifier -22 and may only report 47562. As far as the insurer is concerned, not documented means not done, and not done definitely means not paid.

-- Technical and coding advice for You Be the Coder and Reader Questions provided by Marcella Bucknam, CPC, CCS-P, CPC-H, HIM program coordinator at Clarkson College in Omaha, Neb.