Urology Coding Alert

The new laparoscopy codes make it easier to correctly code urological surgical procedures, but laparoscopic developments have given way to another coding conundrum: how to code a procedure that begins as a laparoscopy and is changed and completed as an open surgery.

A laparoscopy is a minimally invasive surgery in which a thin fiber-optic scope is introduced into a body cavity for diagnostic and surgical purposes. This high-tech procedure is emerging as a popular choice among urologists who perform procedures such as sling suspensions for urinary incontinence (51990-51992), ureteroneocys-tostomies (50945-50948), nephrectomies (50541-50548), and many other urological procedures.

Sometimes change in the patient's health or complications such as poor visibility caused by too much fibrosis or scarring can make it impossible to complete a laparo-scopic surgery, requiring the urologist to complete the procedure as open. And urology practices have found coding these modified surgeries a perplexing task.

Choosing a Coding Method

Michael A. Ferragamo, MD, FACS, assistant clinical professor of urology at State University of New York, Stony Brook, offers three suggestions for coding laparoscopic-turned-open procedures:

The American Urological Association recommends that practices choose Ferragamo's first option. "Code the failed laparoscopic procedure with modifier -52, reduced service, and then code the open procedure as you normally would," the AUA instructs in "Coding Tips for the Urologist's Office" Volume 7, January 2000, page 25.

But others disagree. Morgan Hause, CCS, CCS-P, coding specialist for Urology of Indiana in Indianapolis, favors only the third option. He advocates coding in accordance with CCI Edits Version 7.3, Section C-9 of the Introduction, which states, "when an endoscopic service is attempted and fails, and another surgical service is necessary, only the successful service is reported." This includes instances in which a laparoscopic surgery is attempted and cannot be completed except by means of open surgery. If appropriate, coders can append modifier -22 to the suitable open procedure code to indicate unusual procedural services.

Hause cites the CCI example. "If a laparoscopic cholecystectomy is attempted and fails and an open cholecystectomy is performed, only the open cholecys-tectomy can be reported," he says.

Regardless of the method you use to code a laparoscopy turned open surgery, remember to abide by the following requirements:

However, "Medicare does not pay for -81, minimal assistant," Page says. The reason modifier -81 won't work for surgeons assisting with laparo-scopies is that commercial payers commonly use modifier -81 to indicate nonphysician assistants.

As for modifier -82 (Assistant surgeon [when qualified resident surgeon not available]), Page says, "Medicare limits payment to surgeries performed in teaching facilities," but the policy may vary for commercial payers. Private payers "probably wouldn't need the disclosure provided by the modifier since they don't fund teaching facilities," Page says.