General Surgery Coding Alert
Look for 'Separate Procedure' Bundles
Question: We have an op note that states that the surgeon injected air into the peritoneal cavity before performing laparoscopic splenectomy. I think we should report just 38120, but the surgeon things we should also report 49400. Who is correct?
Connecticut Subscriber
Answer: You are correct that the proper coding for the procedure is 38120 (Laparoscopic, surgicalsplenectomy) alone.
You should not additionally report 49400 (Injection of air or contrast into peritoneal cavity [separate procedure]) for two, very good reasons:
1. When a CPT® code includes a parenthetic note stating “separate procedure” like 49400 does, you shouldn’t report it with another code for a procedure that typically includes the service. In this case, laparoscopic procedures such as the splenectomy described typically involve injecting air into the peritoneal cavity.
2. Medicare’s Correct Coding Initiative (CCI) edits bundle 49400 as a column 2 code with 38120. The code pair has a modifier indicator of “0,” which means that you can never override the edit pair.
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