Primary Care Coding Alert

Question: If groin exploration is an unlisted procedure, which CPT code is appropriate?

Adele Halbreich
Newton, Iowa

Answer: The groin area is listed in the Abdomen, Peritoneum and Omentum section of the CPT manual. Depending on the means of exploration, two codes may be used. If the procedure is done laparoscopically, 49329 (unlisted laparoscopy procedure, abdomen, peritoneum and omentum) should be selected. If the surgery is accomplished as an open procedure, 49999 (unlisted procedure, abdomen, peritoneum and omentum) would be the correct code.

For unlisted procedure codes, the fee should be based on procedures with similar work and physician effort. Unlisted procedure claims must be accompanied by documentation and/or an operative report to inform the payer of the exact procedure performed and to minimize delays in payment.

Answers for You be the Coder and Reader Questions are provided by Tammy Chidester, CPC, billing supervisor at Upshur Medical Management Services Inc., in Buckhannon, W.Va; Kathy Zmuda, CPC, lead inpatient coder for Cigna Health Care of Arizona in Phoenix; Sandy Page, CPC, CCS-P, co-owner, Medical Practice Support Systems Inc., a billing and coding firm in Broomfield, Colo.; and Melanie Witt, RN, CPC, MA, an independent consultant specializing in coding and documentation education based in Fredericksburg, Va.