General Surgery Coding Alert

Question: How should we bill a laparoscopic pyloromyotomy? In general, if our surgeon performs a laparoscopic procedure that doesn’t have a specific code, should we use the open-code for the procedure?

California Subscriber

Answer: You should bill the laparoscopic pyloromyotomy as 43659 (Unlisted laparoscopic procedure, stomach). You should not use the open code for the procedure (43520, Pyloromyotomy, cutting of pyloric muscle [Fredet-Ramstedt type operation]).

General rule: You should never use a code for a surgical procedure if the approach doesn’t match. That is, don’t use an open code for a laparoscopic procedure, or vice versa. Instead, you should use the unlisted code that best describes the service.

You run into this situation as laparoscopic procedures become more common before new, specific laparoscopic codes are available.

Listen to payers: If you have payers that want you to bill differently to avoid using unlisted codes, you should follow their instruction -- but get it in writing.