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General Surgery Coding Alert

Reader Question:

Report Open Procedure When Converting

Published on Thu May 01, 2003

Question: How should I code if the physician must convert a laparoscopic cholecystectomy to an open cholecystectomy? Maine Subscriber Answer: Medicare guidelines specify that you should report the open procedure only when converting from a laparoscopic cholecystectomy. In addition, you should append a secondary diagnosis of V64.4 (Laparoscopic surgical procedure converted to open procedure) to further describe the procedure's circumstances.

If the surgeon performed a significant portion of the procedure laparoscopically before converting to the open procedure, you may append modifier -22 (Unusual procedural services) and increase your fee. But be certain to have sufficient documentation supporting your claim, or the insurer will reject additional payment. 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.  
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