Wiki Staging laparoscopy for cancer

[khoffman]

My group of General Oncology surgeons are starting their surgeries with a "staging lap" code 49320 and then they open and perform the procedure. Since 49320 does not bundle to the opens they have been able to bill these in the past? In the last 18 months I have only seen one case that they did not open for surgery, they aborted due to extensive mets.

What is the medical necessity to do a staging lap on every cancer patient?

 

[Lujanwj]

There isn't medical necessity per se. That could be consider fraud if they already knew what they were going in for. In other words, if it has already been DX'd than there isn't medical necessity for a DX laps. and is fraud. With that said, if it's truly a DX you should be OK. If that's the case, code it and put a V64.41 as a secondary on the open. Either way you need to use V64.41 to show your conversion.

CCI is not a perfect system so don't rely on it for everything. They don't always bundle procedures that have already existing policies or guidelines.