General Surgery Coding Alert

Question: An exploratory laparotomy and wedge biopsy of the liver were performed. The mass was excised, sent to pathology and returned positive. How should this be coded?

Florida Subscriber  
Answer: The correct code for a wedge biopsy of the liver is 47100. Unlike other liver biopsies, it is considered an excision because the surgeon takes a wedge of liver and then sutures the excised edges to prevent bleeding.
 
It may be difficult to obtain payment for the wedge biopsy if it is performed during the same session as another abdominal procedure. Carriers may bundle the two, even though 47100 is not bundled to abdominal procedures (other than more extensive liver procedures) in the Correct Coding Initiative.
 
Different diagnosis codes should be linked to the primary procedure and the wedge biopsy to avoid inappropriate bundling. This means surgeons should wait until the pathology report returns before noting the appropriate diagnosis code for the biopsy. Since the biopsy returned positive, either 155.0 (for a primary liver neoplasm) or 197.7 (for a secondary carcinoma) should be used.
 
If the biopsy had returned negative, the sign or symptom that prompted the surgeon to take the biopsy would be used. For example, a surgeon who discovers a nodule on the edge of the liver as he or she is removing the patient's gallbladder and decides to perform a wedge biopsy would report diagnosis code 211.5 (Benign neoplasm of liver and biliary passages).