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  • Posted by 4743, 1 year ago. There are 3 posts. The latest reply is from 4743.
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  1. How can I code for a laparoscopy, aspiration of peritoneal fluid with culture, needle core liver biopsy? + irrigation and aspiration of abdominal cavity? The diagonis was right upper quadrant anterior peritonitis, pathology report of liver showed cholangitis.

    A supraumbilical incision was made and the veress needle was passed into the abdominal cavity. C02 insufflation was obtained and a 10-mm trocar was placed. A 5 mm trocar was placed in the epigastrium and then the right upper quadrant was viewed. The liver showed an unusual "splotchy" variegated appearance not readily identified by this observer and there was substantial inflammation of the peritoneum over the right diaphragm and in the right upper quadrant anterior peritoneum but not in the remainder of the abdomen. Picutures were taken. The omentum was brought off of the gallbladder and the gallbladder was soft and somewhat collapsed and did not show any signs of inflammation, thickening or wall edema. Thre was retroperitoneal inflammation at the hepatic flexure and extending somewhat down the ascending colon but there was not marked thickening of the colonic wall that usually accompanies a severe colitis. THe appendix appeared normal. The anterior wal lof the ascending colon showed some chronic hypervascularity of unknown etiology. The visible loops of small bowel appeared normal. Sigmoid colon appeared normal> There was a modest amount of cloudy peritoneal fluid, about 10 cc was aspirated and sent for culture. This was not frankly purulent and was not enteric in appearance. Because of the abnormal appearance of the liver and the inflammation over the dome of the diaphragm as well as the abnormal liver function tests and her history of leukemia, it was felt to go ahead and biopsy the liver. A single pass of an 18 gauge needle core divice was performed just to the right of the round ligament and the bleeding was controlled with cautery without difficulty. The abdomen was irrigated and aspirated in all quadrants. No other abnormality was seen and it was elected not to remove this gallbladder even though it is known to contain stones by CT as she is clearly ill from another disease process that I do not want to complcate with an additional surgery in this setting of overall elevated risk. The umbilical trocar was removed etc.

    Can you help me with CPT and diagnosis codes? I'm thinking 49322, unsure of core needle liver biopsy 47379 vs 47001

  2. 49322-should be linked with Dx 789.31 (There is no actual ICD-9 for peritonitis wiht right upper quadrant, only peritonitis code found, which is 567.9, but 567.9 is not a valid dx for procedure 49322, also did not get any LCDs.
    47379-576.1 (because surgeon obtains liver sample through laparoscope). You can compare for any open liver needle biopsy code (such as 47000)
    You would have used +47001 only if it would have not laparoscopic and it should be in conjunction with a separate, primary procedure code. CPT +47001 says surgeon obtains the liver sample using the cutting needle while he is in the abdominal cavity to perform another major procedure.
    47000 is for core liver biopsy needle, percutaneous, which is not the case here.
    47100 is wedge biopsy, percutaneous, which is also not the case here.

  3. Thank you so much for your help and explanation.

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