General Surgery Coding Alert

Question: On several occasions while performing a laparoscopic cholecystectomy (47562) our surgeons have done a liver biopsy (47001), which is an add-on code, with diagnosis codes for the biopsy such as cirrhosis, abnormal liver function tests, etc. Our local Medicare rejects these billings, stating that 47001 can't be billed independently of 47000. Is this correct? Can 47001 be reported with 47562?

Montana Subscriber

Answer: No, the payer is not correct to require 47000* (Biopsy of liver, needle; percutaneous) with +47001 (... when done for indicated purpose at time of other major procedure [list separately in addition to code for primary procedure]), and, yes, you may report +47001 separately with 47562 (Laparoscopy, surgical; cholecystectomy).

Not all add-on codes are created equal: "Each additional" add-on procedures, such as +44121 (Enterectomy, resection of small intestine; each additional resection and anastomosis [list separately in addition to code for primary procedure]) and +44203 (Laparoscopy, surgical; each additional small intestine resection and anastomosis [list separately in addition to code for primary procedure]), are linked to a "parent code" with which they must be reported (in this case, 44120 and 44202, respectively).

Other add-on codes, such as +44015 (Tube or needle catheter jejunostomy for enteral alimentation, intra-operative, any method [list separately in addition to primary procedure]) and +69990 (Microsurgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]) although they must accompany another, more extensive procedure are not linked to any one particular code. Although +47001 shares part of its CPT descriptor with 47000, it is independent of 47000 and falls into this latter category of add-on codes.

Very likely, your payer's software incorrectly links +47001 to 47000, and you will have to file an appeal to get the claim paid. Be persistent: If you do not insist that the payer correct its error, it will continue to reject all similar claims. And remember, add-on codes do not require modifier -51 (Multiple procedures), are not subject to multiple-procedure reductions and should be reimbursed at the full Fee Schedule amount (2.76 relative value units, or about $100, for +47001).