Wiki Laparocopic or Open- Which to Choose

[tclawgirl]

I am working on coding for a colectomy and several other "Digestive" surgeries- I have found that if/when the surgeon pulls out the organs, makes a larger incision (basically, changes the visual field to their eyes instead of the scope) this becomes an open procedure. Since the visual field is no longer the scope it is not laparoscopic.

My surgeons say, "we have done the majority of the work laparoscopically, we only take out the intestine, divide it, staple it and put it back. All of the pairing, shaving, etc was all done laparoscopically so this is a lap-assisted surgery and therefore should be coded as a lap." My chief said this is coded as a lap across the country.

Everything I read says this is open. Can someone please point me in the right direction? The coding books and Procedure answers book doesn't specify.

 

[Kevinph84]

I have always been taught that "mini-open" procedures are coded as open procedures. Perhaps show them examples from arthroscopic procedures notations?

 

[coderica2011]

I am working on coding for a colectomy and several other "Digestive" surgeries- I have found that if/when the surgeon pulls out the organs, makes a larger incision (basically, changes the visual field to their eyes instead of the scope) this becomes an open procedure. Since the visual field is no longer the scope it is not laparoscopic.

My surgeons say, "we have done the majority of the work laparoscopically, we only take out the intestine, divide it, staple it and put it back. All of the pairing, shaving, etc was all done laparoscopically so this is a lap-assisted surgery and therefore should be coded as a lap." My chief said this is coded as a lap across the country.

Everything I read says this is open. Can someone please point me in the right direction? The coding books and Procedure answers book doesn't specify.

I do gastro coding as well & it can be very challenging. Here's what my experience tells me:
If the Dr made initial stabs, placed the trocars & insufflated the abdomen & did the work INSIDE the abdomen, then this is a LAP procedure. But if he/she decides for whatever reason that they need to access the organ(s) by making a larger incision and removing them to the outside of the body, then this is in fact an OPEN procedure. My question is, is the Dr stating why he/she had to make the larger incision? Normally, if the intent was to do a LAP, then unless something out of the ordinary occurs, it should remain a LAP. If the Dr is simply starting out with a LAP & then converting to an OPEN procedure (make sure notes document this) then be sure to code the procedure as an OPEN and use dx code V64.41.
Hope this helps!