General Surgery Coding Alert

Question: The surgeon performed an exploratory laparoscopy with laparoscopic drainage of an intra-abdominal abscess and EGD. The patient recently underwent gastic bypass. Should I use 49322, 49323, or another code?

Codify Member

Answer: You're correct in your inclination to turn to 49322 (Laparoscopy, surgical; with aspiration of cavity or cyst [eg, ovarian cyst] [single or multiple]). Typically you'll see 49322 used for ovarian cysts as suggested in the code descriptor, but it is in fact the correct code for this case as well. You can use 49322 for drainage of any loculated fluid or semi-liquid material.

Beware: You shouldn't use 49323 (...with drainage of lymphocele to peritoneal cavity) because that is for draining the fluid from a hernia sac into the abdominal cavity. The exploratory part is included in the surgical code so you won't report a separate code for that portion of the procedure.

Additionally: Remember that you can report the (EGD -- 43235, Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]), even though the patient had gastric bypass, if there was medical necessity for the surgeon performing the EGD (such as if the patient had nausea, burning, pain, etc.) Don't report the EGD code if it's a case of "while I'm in there I'll take a look at the patient's gastric healing."