General Surgery Coding Alert

Question: What is the correct code for an exploratory laparoscopy converted to an open cholecystectomy? The only code I can think of is 47480 but I don't think that is the correct code to use.

Maryland Subscriber

Answer: You should report 47600 (Cholecyst-ectomy) for this procedure. Code 47480 (Cholecystotomy or cholecystostomy with exploration, drainage, or removal of calculus [separate procedure]) is for cholecystostomy, but in this case you indicate that the surgeon removed the gallbladder, so 47600 would be the appropriate code.

If during a laparoscopic procedure, the surgeon converts to an open surgery, you should only report the open procedure, according to CPT and CMS guidelines.

Warning: Don't be tempted to report the laparoscopic procedure with a modifier, such as 53 (Discontinued procedure) in addition to the open code.

Instead: Use V64.41 (Laparoscopic surgical procedure converted to open procedure) as a secondary diagnosis to document on the claim that the surgeon converted from laparoscopic to open technique. Using V64.41 does not affect the primary diagnosis (for instance, 575.0, Acute cholecystitis).

In addition: You should also use additional diagnosis codes to describe the conditions that lead to the decision to change from the laparoscopic to the open approach. These conditions could include inflammation, extensive adhesions, or other complications.

One option: If the surgeon's exploration was ex-tensive or time consuming, and documentation supports it, you may be able to append modifier 22 (Increased procedural service) to the open cholecystectomy to get reimbursement for that extra work.