Wiki Lap or Open or both?

[jdibble]

I need some help in the correct coding for a this surgery for a patient with diagnosis of chronic cholecystitis, parital small bowel obstruction and umbilical hernia.

My surgeon did a laparoscopic cholecystectomy where the gallbaldder was obscured by adhesions. Once she was finished with the lap procedure she attempted to do lysis of the adhesions laparoscopically but states in order to get a better view had to switch to an exploratory laparotomy. She made a midline incision and attached a GelPort. After inserting a hand she realized this would not be adequet and converted this incision to open to above the umbilicus. She conitnues to lyse numerous adhesions to free the bowel. She also states that during the process the Umbilical Hernia was opened and repaired. The midline incision is closed as well as the port incisions.

The doctor wants to code 47563 for the lap chole with cholangiogram, 49585-59 for the open umbilical hernia, and 44005-59 for the lysis stating that this was separate procedure for the small bowel obstruction.

First question is would the cholecystectomy be coded as open or lap? She was completely finished doing this procedure laparoscopically before she converted to open - or would this procedure now have to be coded as open since she switched to open? Next question is can she or can she not code the 44005 separately since this was supposed to be for the small bowel obstruction and not the cholecystectomy or the hernia? I found information for the lysis - one saying you can bill with the 59 modifier, another saying it is not billable and to bill with the 22 modifier if the lysis was extensive.

Hopefully someone can help - this one has me going aroung in circles!

Thanks,

 

[Peter Davidyock]

I really don't know what she has left to bill outside of the umbilical hernia repair with a 22.
"The lap is gone once the procedure converted to open. No matter the reason for the conversion.
Lysis is considered to be part of the approach and I have found no one that will pay for it when coded with a more specific service.

 

[jdibble]

I really don't know what she has left to bill outside of the umbilical hernia repair with a 22.
"The lap is gone once the procedure converted to open. No matter the reason for the conversion.
Lysis is considered to be part of the approach and I have found no one that will pay for it when coded with a more specific service.

Thanks Oceanlivin for your help! As far as the 22 modifier, she is saying that the adhesions were extensive, but does not document how extensive or the extra time that it took. I have attempted to educate them a number of times on the correct documentation for these instances, but they keep insisting that they should be able to bill the 44005 since it was for another diagnosis - the bowel obstruction - and not the hernia or the cholecystectomy.

As far as the lap or open, thanks - I wasn't sure if I could code the procedure as open when it was completed as a laparoscopic procedure.

Thanks again!