Ob-Gyn Coding Alert

When a laparoscopic gynecological surgery is converted to an open procedure due to intraoperative findings, the accepted rule of thumb is that coders can bill for the open, but not the initial laparoscopic procedure. But using the right modifier may help your practice get paid for the extra work in the operating room.   Check Both Local and National Guidelines   According to the national Correct Coding Initiative (CCI) edits, version 7.1 (April-June 2001), when a second procedure is performed because the initial approach was unsuccessful in accomplishing the required service, "only the CPT code for one of the services, generally the more invasive service, should be reported." 
Many Medicare carriers also have local medical review policies (LMRPs) that address this issue and describe the two procedures (open and laparoscopic) as mutually exclusive. For example, Wisconsin Physician Service, the Medicare Part B carrier in Wisconsin, Illinois and Michigan, states that one reason procedures may be deemed mutually exclusive is if they "represent two methods of performing the same service."
In spite of these guidelines, some surgeons may be confused about how to code the conversion from a laparoscopic to an open procedure, particularly if a lot of time was spent before the decision to convert. If coders are unaware of the guidelines, they may sometimes use inappropriate coding strategies to gain additional reimbursement, but this can lead to denials or even fraud charges.
Modifier -53 Does Not Apply   In the gynecological surgical setting, there are a few scenarios where laparoscopies are converted to open procedures. For instance, an excision of an ovarian cyst that proves to be more complicated than originally thought, or extensive adhesions that must be taken down via an open incision to accomplish the original procedure. 
Although the coding guidelines for this situation are straightforward -- only the open procedure should be billed -- some coders incorrectly code and bill for both the laparoscopic and open procedures by appending modifier -53 (discontinued procedure) to the laparoscopic procedure. While some coders report that their carrier pays such claims, this modifier in this scenario is clearly inappropriate and should not be used, coding experts say. 
The CPT descriptor for modifier -53 states, "Under certain circumstances, the physician may elect to terminate a surgical or diagnostic procedure. Due to extenuating circumstances or those that threaten the well-being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued." Such circumstances include potentially life-threatening situations, such as uncontrollable bleeding, hypotension, neurologic impairment or cardiac arrest.
"Given CPT's explanation, modifier -53 should not be used if the surgeon successfully completes the service, even if another technique is used to complete the service," says Melanie Witt, [...]