Ob-Gyn Coding Alert

Lisa Lorence, a medical billing specialist at the Toledo (Ohio) Clinics department of obstetrics and gynecology offered a comment on one of our reader questions from the October 1999 Ob-Gyn Coding Alert. In the question, a laparoscopic procedure was 90 percent completed, then the doctor had to change to an open procedure. The reader asked whether modifier -53 (discontinued procedure) should be used to indicate the change mid-procedure. We answered that the -53 modifier is used only when a procedure is stopped completely, and that the readers options included 1) coding for the more expensive procedure and appending a -22 modifier (unusual procedural service), or 2) bill for the open procedure on the first line of the claim and the laparoscopic procedure on the second line, using modifier -52 (reduced services).

Lorence shared that ICD-9 code V64.4 (laparoscopic surgical procedure converted to open procedure) has worked for her in a similar situation. We have been successful in billing for the open procedure on the first line and laparascopy on the second line with a -52 modifier for reduced services. The V64.4 code explains that the laparoscopic approach was attempted.