Wiki lap splnic flxr tkdwn w/ open LAR?

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DianeMS

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Hi -

I'm billing what was intended to be a laparoscopic low anterior resection. Mobilization of the splenic flexure was done laparoscopically, then AFTER that the surgery was converted to open, so the low anterior resection was done as an open surgery.

I will bill the open LAR 44145, but for the splenic flexure takedown, should I be using the lap add-on code 44213 since this was done laparoscopically? Can a lap add-on code be used with an open procedure code? Would the ICD-9 code V64.41 explain this and make this combination acceptable?
Or should I use the open add-on code for that (44139)?

I am stumped by this coding scenario.....

Thanks for any help anyone can offer!

~Diane Stumne, CPC
Maple Grove, MN
 
I do not have a good solution to this but we are seeing the same situation. I tried doing the lap mobilization but we have gotten a denial. I did use the V64.41 but it denied. I am in the middle of an appeal and have supplied the notes. I'm not convinced doing the open mobilization is accurate as it was fully done as a lap. I'm anxiously awaiting the results of the appeal to see if they accept it. I would love to hear other feedback as well.
 
We run into this all the time and have been coding it as an open 44139. My understanding is once the lap is converted to open, the entire procedure is considered open.
 
Thanks!

Thanks for the feedback everyone, I appreciate it! I did end up submitting this case with all open codes. Although llike Michelle, I feel that doesn't report an accurate picture of what was really performed, as the splenic flexure takedown was fully done laparoscopically. (Michelle, I'm very interested to hear the results of the appeal you're waiting on. Pls post update when you hear?)

Thanks again!

~Diane:)
 
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