Maarit Posted Thu 26th of May, 2011 18:07:31 PM
I would appreciate feed back on this one. The surgeon performed first dissection and mobilization of the bowel laparoscopically. Then he made an incision to remove the specimen and to accomplish a side-to-side anastomosis.
I wonder if CPT 44120 alone is adequate? I know Medicare quidelines say that any lap approach before converting to open surgery is bundled. The PT has Medicaid.
SuperCoder Answered Thu 26th of May, 2011 23:00:47 PM
According to Medicare, reporting both a laparoscopic and an open surgical approach to accomplish the same clinical outcome represents duplicity of efforts and overlapping of services.
Concept of using modifier 53 is specifically not allowed in this case by Medicare.
Depending on the amount of time the surgeon spent on the Laparoscopy assisted partial small-bowel resection before deciding to switch to an open procedure, he or she can attach modifier -22 (unusual procedural services) to the open procedure (Enterectomy, resection of small intestine; single resection and anastomosis). When submitting claims using modifier -22, the surgeon must provide full documentation to indicate why the procedure should be reimbursed at a higher rate.
In the case of the Laparoscopy assisted partial small-bowel resection converted to an open, the extra time and effort should be indicated in a separate note. If the decision to switch to the open procedure was made soon after the procedure began, modifier -22 should not be included.