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Correct codes to use

Maria Posted Tue 14th of October, 2014 12:54:26 PM

Please help with the coding question. If just in case, clarifications are needed from Leesa- please do so.

Scenario: My doctor was planning on performing a robotic prostatectomy. After placing all the ports, it was clear that pt had a colovesical fistula with a diverticular abscess. Another doctor- a general surgeon came and repair his bowel. My doctor repaired a small hole in the bladder and did not move forward with prostatectomy.
My doctor is trying to figure out how to code this. My doctor believes that we can code unlisted laparoscopic procedure code 51999 and then benchmark the code 51865 for the closure of cystotomy. My doctor cannot bill the fistula repair because the general surgeon performed the bowel portion. Please help. Thank you.

SuperCoder Answered Wed 15th of October, 2014 06:20:34 AM

For open closure of colovesical fistula, there are two codes; 44660 (Closure of enterovesical fistula; without intestinal or bladder resection) and 44661 (...with intestine and/or bladder resection).

However, there is no code available for same procedure when done laparoscopically. For laparoscope procedure, you may use either of the two codes; 44238 (Unlisted laparoscopy procedure, intestine [except rectum]), or 51999 (Unlisted laparoscopy procedure, bladder). Work done for closure of cystotomy is included in unlisted code.

Unlike open procedure codes where a general surgeon and urologist may report for both the procedure as co surgeon using modifier 62, you may not use any modifier with unlisted code. There is only one way left that each provider bills for their part of the procedure using unlisted code specific to anatomical area addressed by them. Urologist may only bill 51999 for laparoscopic repair of bladder and general surgeon may bill 44238 for laparoscopic work done on intestine.

Thanks !!

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