How to Bill for Laparoscopic Procedures When There's Only an Open Code Available
Published on Sun Aug 01, 1999
If theres no appropriate laparoscopic procedure code available, many ob-gyn coders make the mistake of thinking that its okay to use the CPT code for the open approach when the procedure is actually performed laparoscopically. For example, coders think that when a laparoscopic Burch is performed, a procedure which reduces urinary incontinence following childbirth, they can use 51840 (anterior vesicourethropexy, or urethropexy; [e.g., Marshall-Marchetti-Krantz, Burch]; simple). But unless the procedure is done via the open approach, in which the physician cuts through the abdomen, the correct code is 56399 (unlisted procedure, laparoscopy, hysteroscopy).
In other words, just because something can be done by laparoscope doesnt mean theres a specific code for it.
Unlisted Laparoscopy Code Only Option
If a doctor is performing a procedure that has a CPT code that only describes the open procedure, but is doing it as a laparoscopic procedure, the doctor has to use the unlisted laparoscopy procedure code, explains Melanie Witt, RN, CPC, MA, program manager for the department of coding and nomenclature for the American College of Obstetricians and Gynecologists (ACOG). There is a CPT code for Burch, but it only describes the open approach, adds Witt. You cant use that code for the procedure done laparoscopically.
Tip: In next years CPT 2000, there will be a laparoscopic code for Burch. And it will be right next to the open one; the laparoscopic codes will be scattered throughout the CPT manual, instead of all in one place the way they are now.
Many procedures can be either open or laparoscopic, says Carolyn Roberts, CCS, CCS-P, CPC, coding and reimbursement analyst specializing in ob-gyn for the Springfield, MA-based Bay State Medical Education and Research Foundation, where she bills for about 50 ob-gyns. If a CPT code is available for the open approach, it is very tempting for the coder to use the open procedure code, she adds. Thats because theres a lot more work involved with using the unlisted code. With the open codeeven if its wrongit seems easier to use it. You usually get paid faster, says Roberts. But its incorrect, and later if the carrier discovers they paid an incorrect code, you might have to pay them back, or you may even be fined.
Roberts admits that unlisted codes are a pain. We get denials when we use them, she relates. But thats the insurance companys fault. When she appeals, she gets paid. If no specific code exists for what you did, you cant just go to the open code, Roberts reiterates. You have to use the unlisted code.
If we report a laparoscopic procedure as an open one, then the data is being used to compare clinical outcomes, average [...]
