General Surgery Coding Alert
When Converting, Report Only the Open Procedure
Question: How should I code if the surgeon must convert to an open procedure during laparoscopic cholecystectomy? A substantial portion of the work was completed laparoscopically before the conversion. New York Subscriber Answer: CPT does not provide instruction on this situation, but Medicare guidelines dictate that you may report only the open procedure, regardless of how much of the procedure the surgeon completed laparoscopically. Specifically, instructions provided in the introductory portion of the national Correct Coding Initiative (CCI) state, "When an endoscopic service is attempted and fails and another surgical service is necessary, only the successful service is reported" [emphasis added]. The guidelines continue, "For example, if a laparoscopic cholecystectomy is attempted and fails and an open cholecystectomy is performed, only the open cholecystectomy can be reported." Most third-party payers follow the same convention. Therefore, you may report only 47600 (Cholecystectomy) for the open procedure. You cannot claim any portion of 47562 (Laparoscopy, surgical; cholecystectomy), although you may achieve additional compensation if the procedure was especially difficult and/or time-consuming and documentation supports the use of modifier -22 (Unusual procedural services). 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.
General Surgery Coding Alert
- Cut Out the Confusion of Lesion Excisions
For 2003, CPT significantly revises its guidelines for reporting excision of benign (11400-11471) and malignant [...] - Repairs with Lesion Excision Arent an Open-and-Shut Case
Physicians and coders should remember that in most cases, lesion excision will include closure, depending [...] - Watch Incision versus Margins When Calculating Diameter
When calculating excision diameter, be careful not to confuse the length of the incision with [...] - You Be the Coder:
Watch Dx and Modifiers with Thrombectomy
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By Eric Sandham, CPC Under new Medicare rules, teaching physicians will find it easier to [...] - Reader Question:
Use Modifier -78 with Wound Dehiscence
Question: The wound repair article in your December 2002 issue failed to mention wound dehiscence [...] - Reader Question:
Check with Payer Before Applying Modifier -66
Question: Are there any special requirements for appending modifier -66? Maine Subscriber Answer: Apply modifier [...] - Reader Question:
Private Payers May Reimburse Telephone Codes
Question: Our physician spent 20 minutes during office hours on the phone providing advice and [...] - Reader Question:
Conscious Sedation
Question: I have read that conscious sedation by a physician performing an endoscopy is not [...] - Reader Question:
When Converting, Report Only the Open Procedure
Question: How should I code if the surgeon must convert to an open procedure during [...] - Keep Tabs on Surgeons Whereabouts to Avoid Incident-To Snafus
A surgeon's phone call is not enough to allow a surgery practice to bill "incident-to" [...] - CMS Allows Incident-To Billing for Shared E/M Services
Thanks to a recent CMS revision to its E/M rules, general surgery practices stand to [...] - Medical Necessity Is Critical for 99211 Reimbursement
Do patients come into the office for blood pressure checks or other brief E/M services [...] - Test Yourself:
A 99211 Coding Checkup
How much do you really know about when to report code 99211? Take the following [...] - Reader Question:
99211 Isnt Just for Nurses
Question: We employ a physician assistant (PA) who performs all levels of E/M services. We [...] - Reader Question:
Use HCPCS Modifiers to Report PA Surgery Assist
Question: When a physician assistant (PA) assists in surgery on an outpatient basis, does this [...] - Reader Question:
Physician Oversight Required for Critical Care
Question: Is it appropriate to include the time that our PA spends with a patients [...] - Reader Question:
Dual Diagnosis Presents Incident-To Options
Question: A physician assistant (PA) or a nurse practitioner (NP) is treating a patient incident-to [...] - Reader Question:
Bill Incident-To the Resident Doc
Question: One of our doctors treated a patient for an abscess at the site of [...]
