General Surgery Coding Alert

Question: My surgeon did a laparoscopic pyloroplasty. I don't see a code for this procedure. Should I use 43800?

Oklahoma Subscriber

Answer: You should not use 43800 (Pyloroplasty). That code is strictly for an open pyloroplasty.

You are correct, however, that CPT offers no specific code for a laparoscopic pyloroplasty. Therefore, you need to use the unlisted procedure code: 43659(Unlisted laparoscopy procedure, stomach).

Report the unlisted procedure code and in your documentation to the payer, compare the procedure to the work involved with 43800 unless the surgeon stated that there was a big difference in the work involved for a lap procedure versus an open one. This way the payer can base its payment on a similar procedure's pay.

Supply documentation: When submitting an unlisted-procedure claim, your supporting documentation should include the complete operative note and an explanatory covering letter. You can compare the unlisted procedure to 43800 within this supporting documentation.

-- Technical and coding advice for You Be the Coder and Reader Questions provided by Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, CPCOBGYN, CPC-CARDIO, manager of compliance education for the University of Washington Physicians (UWP) Compliance Program.