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Laproscropic turned into open procedure.

Stephanie Posted Thu 02nd of September, 2010 07:18:25 AM

What codes would you use for lower anterior resection with anal anastomosis and divered ileostomy with mobilization of splenic fixture which was converted to an open procedure?

Any help would be greatly appreciated.

Thanks, Michele

SuperCoder Answered Thu 02nd of September, 2010 14:01:34 PM

When your surgeon converts a surgical lap procedure to an open procedure, you can only report the open procedure code. You'll use the diagnosis code to tell the payer about the lap-to-open conversion. Use V64.41 (Laparoscopic surgical procedure converted to open procedure) as a secondary diagnosis to document on the claim that the surgeon converted from laparoscopic to open technique. Using V64.41 does not affect the primary diagnosis.

So you'll report the open procedure codes. Take a look at 44145 for the LAR (which is a colectomy) and +44139 for the take-down of the splenic flexure.

Because open conversion cases often take much longer than a similar procedure that is open from the start, you might be able to use modifier 22 (Increased procedural services). The surgeon must document the extra work and time for you to be able to use this modifier.

Hope that helps!

Best,
Leesa

Leesa A. Israel, CPC, CUC, CMBS
Executive Editor, The Coding Institute

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