General Surgery Coding Alert

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.