Wiki Laparoscopic-assisted colectomy

[KimberlySherman]

Please help me decide the best way to code this procedure: the surgeon performs laparoscopy to mobilize the entire area of colon that will be excised, along with duodenum or rectum if necessary. Then, the laparoscopic instruments are removed. The surgeon then widens one of the trocar incisions to create an opening of about 4-6 cm. He/she then exteriorizes the area of colon that is of concern through this small incision, performs the excision and anastomosis, then drops the colon back into the abdomen. Then he/she closes the incisions and they are done.

What is the best way to code this type of procedure? Sometimes a hand port is also involved, which I have found through research is still considered laparoscopic. But I can't find anything that supports how to code this. Here are the options I see:

1. laparoscopic code
2. open code
3. open code + 22, box 19: laparoscopic-assisted procedure

What do you think and why?

Thank you in advance!

 

[Peter Davidyock]

I have been told by my local medicare carrier that there is no way a laproscopic procedure will be paid once it's been converted to an open procedure.
They expect us to submit the open procedure with a 22 modifier and a v-code.