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Ob-Gyn Coding Alert

When Lap Procedures Become Open,Modifiers Can Help

From the Ob-Gyn Coding Alert
Extra Supplement on Endoscopic Procedures   When the ob-gyn must convert a laparoscopic procedure into an open surgery because of intraoperative findings, use the right modifier to ensure your practice gets the reimbursement for the extra work involved in the operating room. The current accepted rule of thumb when reporting a laparoscopy that becomes open maintains that you can bill for the open procedure, but not the initial laparoscopic portion. According to the most recent Correct Coding Initiative (CCI) edits, version 8.3, "when an endoscopic service is attempted and fails and another surgical service is necessary, only the successful service is reported." Generally, the successful service is the more invasive, CCI continues. Note that this is a published Medicare rule that may or may not be in place with non-Medicare payers. Nonetheless, coders may still be confused about how to report the conversion from a laparoscopic approach to an open procedure, especially when the ob-gyn spends a large amount of time before he or she decides to convert. If coders are unaware of the guidelines, they may use inappropriate coding techniques to gain additional reimbursement, which may lead to claim denials and fraud allegations.

Use Modifier -22 With Special Circumstances One strategy you might use when the physician converts from a laparoscopic procedure to open surgery would be to report only the open procedure appended with modifier -22 (Unusual procedural services), says Dee Mandley, RHIT, CCS, CCS-P, director of HIS and education for CURES, a coding and compliance consulting firm in Twinsburg, Ohio. But you should use this modifier only if the documentation indicates that the open procedure was significantly more difficult than usual. The fact that the ob-gyn converted the procedure is not enough. If the physician switched the approach shortly after beginning the procedure, modifier -22 would not be appropriate.

Philip Eskew Jr., MD, medical director of women and infants' services at St. Vincent's Hospital's Family Life Center in Indianapolis, agrees that modifier -22 may be the answer: "I favor using the -22 modifier when it becomes necessary to convert to an open procedure. First, it was not planned. Second, it is not my routine to perform a diagnostic laparoscopy before opening. And third, I would document extensively why I did it, what I saw that caused me to convert, how I did it, and how it benefited the patient."

Attaching this modifier should depend on the type of problems the surgeon runs into. You should use modifier -22 only when the physician feels that he expended a great deal of extra time and expertise. If the ob-gyn commonly converts from laparoscopic to open, you should not use modifier -22 because this conversion is "normal" [...]

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