General Surgery Coding Alert

Question: If the surgeon performs a substantial portion of a cholecystectomy laparoscopically before converting to an open procedure, may I report both codes?


Pennsylvania Subscriber


Answer: No, you may not report both procedure codes. You should claim 47600 (Cholecystectomy) only, for the open procedure.

Medicare guidelines dictate that you may report only the open procedure, regardless of how much of the procedure the surgeon completed laparoscopically. Specifically, instructions in the introductory portion of the National Correct Coding Initiative state, -When an endoscopic service is attempted and fails and another surgical service is necessary, only the successful service is reported- [emphasis added].

The NCCI guidelines further specify, -For example, if a laparoscopic chole-cystectomy is attempted and fails and an open cholecystectomy is performed, only the open cholecystectomy can be reported.-

You should include a secondary diagnosis of V64.41 (Laparoscopic surgical procedure converted to open procedure) to show that the surgeon converted from a laparoscopic approach. Applying V64.41 does not affect the primary diagnosis (for instance, 575.0, Acute cholecystitis), which should remain the same, regardless of the surgeon's surgical approach.

You cannot claim any portion of 47562 (Laparoscopy, surgical; cholecystectomy), even by appending modifier 53 (Discontinued procedure). You may, however, achieve additional compensation if the surgeon can provide documentation that the procedure was especially difficult and/or time-consuming. In this case, you may append modifier 22 (Unusual procedural services) to 47600, but expect some resistance from the payer and the possible need for an appeal to gain reimbursement.

Technical and coding advice for You Be the Coder and Reader Questions provided by Marcella Bucknam, CPC, CCS, CPC-H, CCS-P, HIM program coordinator at Clarkson College in Omaha, Neb.