Medicare Compliance & Reimbursement

Open versus laparoscopic is one of several important factors.

Do you want to be sure that you're reporting cholecystectomy claims correctly--without leaving money on the table? Here are four steps that will allow you to tackle that operative note with confidence. 1. Choose Between Open and Laparoscopic Approach

To begin, you must determine whether the surgeon performed the cholecystectomy via an open approach or using a laparoscope. For laparoscopic procedures, you should choose your code from the 47562-47564 range. For open cholecystectomy, you should stick with 47600-47620. 2. Report All Associated Procedures

You must also consider whether the surgeon performed any other procedures at the time of the gall bladder removal, such as cholangiography or common duct exploration. Failure to report these procedures, when performed, means that your surgeon will not receive all the reimbursement he deserves for his effort.

For example: "Many surgeons perform cholangiography [radiologic examination of the bile ducts] as a standard component of cholecystectomy," says M. Trayser Dunaway, MD, FACS, CSP, CHCO, CHCC, a surgeon, speaker, physician and coding educator, and healthcare consultant in Camden, SC. "Because the surgeon considers the cholangiography routine, he or she may fail to note the procedure in the operative report summary. If you don't read the body of the operative report, you may miss the cholangiogram, as well as the reimbursement that comes with it."

Avoid this overcoding mistake: If the surgeon performs both cholangiography and exploration of the common bile duct (to locate and remove gallstones, for instance), you should report only 47564 (Laparoscopy, surgical; cholecystectomy with exploration of common duct) for laparoscopic approach or 47610 (Cholecystectomy with exploration of common duct) for an open procedure.

Here's why: The National Correct Coding Initiative bundles 47563 (Laparoscopy, surgical; cholecystectomy with cholangiography) into 47564, and likewise includes 47605 (Cholecystectomy; with cholangiography) in 47610. Both edits include a "0" modifier indicator, meaning that you may never override them. Payers will always include the work involved in cholangiography in exploration of the common ducts.

3. Claim Only Open Procedure for Conversions

If, during a laparoscopic cholecystectomy, the surgeon must convert to an open surgery due to inflammation, extensive adhesions or other complications, you should report the open procedure only, according to CPT and CMS guidelines.

Coding 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 (Cholecystectomy).

Don't report a "failed" lap chole: Because the surgeon began with a lap chole, you may be tempted to report 47562 with modifier 53 (Discontinued procedure) in addition to 47600, but this is incorrect. 4. Append 22 if Circumstances Warrant

If the [...]