General Surgery Coding Alert

Question: The surgeon performed diagnostic laparoscopy with lysis of adhesions, followed by laparoscopic cholecystectomy, needle liver biopsy and umbilical hernia repair. How should I code this session?


Mississippi Subscriber

Answer: You can probably report only two codes in this instance: 47562 (Laparoscopy, surgical; cholecystectomy) for the laparoscopic cholecystectomy and +47001 (Biopsy of liver, needle; when done for indicated purpose at time of other major procedure [list separately in addition to code from primary procedure]) for the liver biopsy.

You cannot report the diagnostic laparoscopy (49320, Laparoscopy, abdomen, peritoneum and omentum, diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) because, according to CPT and CMS guidelines, surgical endoscopy always includes diagnostic laparoscopy. Therefore, 47562 includes 49320 in this case.
 
Likewise, you cannot report 49585 (Repair umbilical hernia, age 5 years or over; reducible) if the surgeon repaired the umbilical hernia when closing one of the gallbladder incisions. In such a case, the hernia repair is included as a necessary component of the lap chole.

Possible exception: If the hernia repair was unrelated to the lap chole (that is, if the surgeon made a separate incision to repair the hernia), you may report the procedure separately using 49585. You should append modifier 59 (Distinct procedural service) to 49585 to indicate that the procedure was separate and distinct from the lap chole.

Finally, lysis of adhesions is considered a part of the procedure approach, and therefore you cannot report a separate code for this service.

Modifier 22 is a possibility: If the surgeon thinks that the adhesions made the procedure especially difficult or time-consuming - and has the documentation to back up his assertion - you might append modifier 22 (Unusual procedural services) to 47562. If you choose to do this, be sure to include full documentation with your claim and request additional payment that reflects the extra work the surgeon encountered as a result of lysing the adhesions.