General Surgery Coding Alert

Coding Case Stddy: Billing for Liver Biopsy and Partial Colectomy

- Published on Wed, Dec 01, 1999
When billing for liver biopsies, coders must carefully read the operative report to bill correctly and obtain maximum reimbursement for their general surgeon. Because percutaneous liver biopsy is a commonly performed procedure, coders may automatically bill for it. Therefore, if their surgeon does not let them know that another type of biopsy was performed and if they do not read the operative note thoroughly, they would not know if the procedure that actually was performed should be charged at a much higher rate.

The following operative report is a good example because an unwary coder might incorrectly code not only the liver biopsy but also the right hemicolectomy indicated at the top.

Pre-operative diagnoses: Carcinoma of the cecum; submucosal mass of the transverse colon; chronic obstructive pulmonary disease (COPD); coronary artery and hypertensive heart disease with transvascular heart block.

Post-operative diagnoses: Same.

Procedures: Insertion of temporary transvenous pacemaker, insertion of left subclavian IV, right hemicolectomy, liver biopsy.

History: This 75-year-old man presented with severe anemia and was found to have a carcinoma of the cecum, along with a submucosal tumor in the right transverse colon. He also has a history of severe COPD requiring home oxygen and coronary artery disease with a right bundle branch block, left anterior hemiblock and delayed conduction through the left posterior bundle. He also has renal insufficiency and diabetes. He needs a temporary pacemaker in case the conduction becomes a complete block.

He also needs a subclavian IV for additional venous access. It is hoped that the submucosal tumor of the transverse colon can be removed with the standard right hemicolectomy.

Procedure: A thin wall needle was passed into the [patients] subclavian vein and a guide wire advanced. Initially, the guide wire would not advance and the vein was recannulated. Fluoroscopy showed good position in the chest ... The pacemaker wire was inserted through the introducer kit ... The generator was attached ... The pacemaker was turned off and left in place to be used if he developed a bradycardia. The introducer sheath was sutured in place and a dressing applied and wire taped
in place.

A left subclavian IV was then placed ... A small skin incision was made on the left side at the junction of the clavicle and first rib. The thin-walled needle was passed into the subclavian vein and a guide wire advanced. The dilator was then passed over the guide wire, followed by the triple lumen catheter. This was positioned just above the right atrium under fluoroscopy.

The abdomen was then prepped and draped. A supraumbilical transverse incision was made, extending from the right lateral abdomen to just across the midline and the abdomen entered. The abdomen was explored. [...]

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