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Laparoscopy assisted partial small-bowel resection

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.
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Concept of using modifier 53 is specifically not allowed in this case by Medicare.
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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.

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