General Surgery Coding Alert

Question: Sometimes for patients who have had prior abdominal surgeries, our surgeon will perform a diagnostic laparoscopy before inserting a peritoneal dialysis catheter to ensure adequate space for an effective peritoneal dialysis treatment. Can we bill the diagnostic lap in addition to the code for the catheter insertion?

Pennsylvania Subscriber

Answer: You should not separately code a diagnostic laparoscopy immediately preceding the procedure to insert a peritoneal dialysis catheter. Whether the catheter insertion is laparoscopic or open, you'll have to bundle the diagnostic laparoscopy.

Lap catheter insertion: You must always bundle diagnostic orexploratory laparoscopies into codes for surgical laparoscopy. That means if the surgeon performs a diagnostic laparoscopy (49320, Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) and laparoscopic catheter insertion (49324, Laparoscopy, surgical; with insertion of tunneled intraperitoneal catheter), you should only report 49324.

Open catheter insertion: If the surgeon performs the 49320 service and an open catheter insertion (49421, Insertion of tunneled intraperitoneal catheter for dialysis, open), you'll have to contend with a Correct Coding Initiative (CCI) edit that restricts your coding. CCI lists 49320 as a column 2 code for 49421 with a "0" modifier indicator, meaning that you cannot bill these two codes together under any circumstances.

Bottom line: You can't separately bill the diagnostic laparoscopy associated with the intraperitoneal catheter insertion.