Ob-Gyn Coding Alert

You Be the Coder: Laparoscopy and Laparotomy

- Published on Fri, Sep 01, 2000
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: How should I code the following:
diagnostic laparoscopy open; exploratory laparotomy; excision of left pelvic mass; and significant dissection of intra-abdominal adhesions? The diagnosis was complex left adnexal mass.

Missouri Subscriber

Answer: First, determine the CPT codes for each aspect of the procedure performed. In this case, 49320 (laparoscopy, surgical, abdomen, peritoneum, and omentum; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]), 49000 (exploratory laparotomy, exploratory celiotomy with or without biopsy[s] [separate procedure]), 49200 (excision or destruction by any method of intra-abdominal or retroperitoneal tumors or cysts or endometriomas) and 58740 (lysis of adhesions [salpingolysis, ovariolysis]).

According to the Correct Coding Initiative, when any open abdominal procedure is performed, an exploration of the surgical field routinely is performed to identify anatomic structures or any anomalies that may be present. Accordingly, an exploratory laparotomy (49000) is not billed separately with any abdominal procedure. Thus 49000 is eliminated from the list. A diagnostic laparoscopy (49320) is labeled as a separate procedure. This statement indicates that the procedure, although it can be performed separately, is generally included in a more comprehensive procedure and the service may not be reported when a related, more comprehensive service is performed. This eliminates 49320 from the list. This leaves the excision of the pelvis mass (49200) and the lysis of adhesions (58740) as billable services. When multiple surgical procedures are reported, the most expensive procedure is reported first. Modifier -51 (multiple procedures) is appended to the lesser of the two procedures, in this case 58740.

Question answered by Cynthia DeVries, RN, BSN, CPC, coordinator of coding and reimbursement for Lee Physician Group, a 140-physician multispecialty group that includes 25 ob/gyn providers based in Fort Myers, Fla. She is a member of the American Academy of Professional Coders.

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