Wiki Question about CPT code 49203

[sjackson]

My provider does a Robotic Assisted Lap destruction of Endometrial Lesions that he says is very extensive and requires more work than the 58662. He wants to use the 49203. The code says its an OPEN destruction of Endometriomas.

Does a Laparoscopy incision warrant as OPEN?

 

[Joanne Raissis]

49203

same exact question I was going to ask. There does not seem to be an extensive laparoscopic code for this.

 

[prattkm]

If the physician is doing the procedure Laproscopically, you cannot use an open code. The 49329 is the more appropriate code to use. When billing the code, override the standard description with what they actually did. You will also have to figure out what they will charge for this procedure. If 49203 is the closest to the code, I would take the cost of that and add 25% to the price. When you submit the claim, prepare yourself to be able to have the operative note ready to appeal along with a letter from the Doc stating why the procedure is more extensive. It won't be any easy fight, but that is the only way they will create new codes for the procedures.

 

[Anastasia]

I would use a -22 modifier on the 58662 and send the op report & supporting documentation from the provider. 49329 is an unlisted code and the 58662 is closer to what he did.