General Surgery Coding Alert

Question: What is the appropriate code for a "lap-assisted" colectomy? The surgeon makes an incision, brings the colon into the abdomen, performs the excision and anastomosis and returns the colon, using the laparoscope to lyse adhesions. Does this count as an open procedure?

Maryland Subscriber

Answer: Yes, you should treat a laparoscopically assisted colectomy as an open procedure. Therefore, the appropriate code is 44152 (Colectomy, total, abdominal, without proctectomy; with rectal mucosectomy, ileoanal anastomosis, with or without loop ileostomy) rather than 44211 (Laparoscopy, surgical; colectomy, total, abdominal, with proctectomy, with ileoanal anastomosis, creation of ileal reservoir [S or J], with loop ileostomy, with or without rectal mucosectomy).

Medicare guidelines clearly stipulate that if the surgeon converts a laparoscopic procedure to an open procedure, you should report only the open procedure -- even if the surgeon performed a significant portion of the work laparoscopically. In this case, the surgeon takes a "hybrid" approach to the surgery, but because he makes the incision and performs a portion of the work as an open procedure, you must report 44152 only.