General Surgery Coding Alert

Question: Our surgeon began a laparoscopic cholecystectomy but, due to inflammation, converted to an open procedure to finish the operation. Can we report 47562 with modifier 53, along with 47600 for the open procedure? The surgeon spent considerable time on the laparoscopic approach before the conversion.

Colorado Subscriber

Answer: Because the surgeon began with a lap chole, you may be tempted to report 47562 (Laparoscopy, surgical; cholecystectomy) with modifier 53 (Discontinued procedure) in addition to 47600 (Cholecystectomy), but this is wrong.
 Instead, if the surgeon must convert to an open (non-laparoscopic) surgery due to inflammation, extensive adhesions or other complications, you should report only the -successful- (that is, the open) procedure, according to correct coding guidelines.
 
Example: During the initial approach of a lap chole, the surgeon finds that the patient's gallbladder is severely inflamed and surrounded by difficult adhesions. The surgeon decides to abandon the laparoscope and perform an open (excisional) cholecystectomy instead. In this case, you should report 47600.
  
If the surgeon spends a long time attempting to complete a laparoscopic procedure before ultimately converting to an open approach, you may be able to use modifier 22 (Unusual procedural services) to account for the extra effort and boost reimbursement.
 
Example: After spending 40 minutes lysing adhesions laparoscopically and moving toward the gallbladder, the surgeon encounters excessive inflammation. Due to these complications, the surgeon decides to abandon the scope and proceed with an open approach. In this case, because of the significant additional effort, you may append modifier 22 to 47600. Again, you must be sure that documentation supports your claim.
 
Tip: When the surgeon converts a lap chole to an open procedure, be sure to include V64.41 (Laparoscopic surgical procedure converted to open procedure) as a secondary diagnosis. Using V64.41 does not affect the primary diagnosis (for instance, 575.0, Acute chole-cystitis), which should remain the same, regardless of the surgeon's surgical approach.
 
You should also add additional diagnosis codes to describe the conditions that lead to the decision to change from laparoscopic to open approach. These conditions could include adhesions, abscess or others.