General Surgery Coding Alert

Question: My surgeon did a diagnostic laparoscopy on the liver. He drained a cyst and did multiple liver biopsies. The pathology report showed adenocar-cinoma. Should I use 49321 or an unlisted-procedure code for laparoscopy in the liver section?

North Dakota Subscriber

Answer: You should avoid unlisted-procedure codes whenever possible, so 49321 (Laparoscopy, surgical; with biopsy [single or multiple]) is probably a better choice. In this case, 49321 and 49322 (... with aspiration of cavity or cyst [e.g., ovarian cyst][single or multiple]) may be billed.

However, because both codes are in the same laparoscopic group, the multiple-endoscopy rule applies and reimbursement for the second procedure will be reduced significantly. The higher-paying procedure (49322) should be listed first and will be reimbursed at 100 percent. Code 49321 is listed next: The carrier will subtract the number of relative value units (RVUs) assigned to the base code for the group (49320) from the number of RVUs assigned to 49321 to determine reimbursement.

Some general surgery practices shy away from 49322 because the code descriptor uses the example of an ovarian cyst. The code, however, applies to any abdominal cyst that is aspirated laparoscopically (not just an ovarian cyst).

You Be the Coder and Reader Questions were answered by Pamela Biffle, CPC, CCS-P, coding director for Concentra, an occupational healthcare group in Addison, Texas; Marcella Bucknam, CPC, a coding and reimbursement instructor at Clarkson College in Omaha, Neb., and a longtime general surgery coding specialist; Barbara Cobuzzi, MBA, CPC, CPC-H, a coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Lakewood, N.J.; M. Trayser Dunaway, MD, FACS, a general surgeon in private practice in Camden, S.C.; Elaine Elliott, CPC, a general surgery coding and reimbursement specialist in Jensen Beach, Fla.; Anne Karl, RHIA, CPC, CCS-P, compliance coordinator with Surgical Consultants, a 10-surgeon practice in Edina, Minn.; and Kathleen Mueller, RN, CPC, CCS-P, a general surgery coding and reimbursement specialist in Lenzburg, Ill.