General Surgery Coding Alert

Question: Can we report a cholecystectomy at the same time as a whipple procedure if the reason for the chole is chronic inflammation or sludge? I have reported these procedures together with modifier 59, but Medicare denied the claim.

Washington,D.C.,Subscriber

Answer: A standard radical pancreaticoduodenectomy, or Whipple procedure (48150, Pancreat-ectomy, proximal subtotal with total duodenectomy, partial gastrectomy, choledochoenterostomy and gastrojejunostomy [Whipple-type procedure]; with pancreatojejunostomy), typically includes removal of the gallbladder and ligature of the cystic duct.

Sludge is not usually a priority when a patient requires a Whipple, and your surgeon probably didn't remove the gallbladder for that reason. Rather, he likely removed the gallbladder to avoid any subsequent problems (sludge or otherwise).

The national Correct Coding Initiative bundles open cholecystectomy (47600) to 48150. The edit does contain a "1" indicator, however, which means that you could attach modifier 59 (Distinct procedural service) to 47600 to override the edit under certain conditions.

For example, if documentation shows that the patient had chronic or acute cholecystitis -- and was symptomatic when the surgeon made the decision to perform the Whipple -- you could conceivably report 48150 separately. But such an occurrence would be rare. The pathology report would have to show chronic inflammation, and the surgeon would have to note this in the documentation, as well.