Reporting a Cholecystectomy and an Umbilical Hernia at the Same Operative Session

Question:

If a patient undergoes an open cholecystectomy and has a reducible umbilical hernia repaired during the same operative session, through separate incisions, can both be reported?

Answer:

Yes, if both procedures were performed through separate incisions both may be reported. Conversely, if both were repaired through the same incision, only the cholecystectomy would be reported.

*This response is based on the best information available as of 08/08/19.

Billing for an iatrogenic injury, my patient.

Question:

The surgeon reported an intestinal perforation caused by a trocar during a laparoscopic cholecystectomy due to extensive adhesions.  He completed the cholecystectomy and also did a suture repair of one perforation of the small intestine. How is this reported?

Answer:

Iatrogenic, intraoperative complications that are repaired at the same operative session are not separately reported. Since the small bowel perforation was an iatrogenic injury, inadvertently done by the surgeon during a surgery, it is not reported. Only the cholecystectomy should be reported.

*This response is based on the best information available as of 06/06/19.

Peritoneal Catheter Placement

Question:

I placed the peritoneal catheter for a neurosurgeon placing a V-P shunt. Do I code 49419, insertion of peritoneal catheter?

Answer:

No, you are a co-surgeon with the neurosurgeon. Code 62223, creation of a ventriculo-peritoneal shunt, include both the neurosurgeon’s portion of placing the ventricular catheter and your portion of placing the peritoneal catheter. Both surgeon will report 62223-62.

*This response is based on the best information available as of 2/14/19.

Modifier 59 and 51. Do we need both?

Question:

Should we append both 59 and 51 when a code is bundled and is also a subsequent procedure?

Answer:

Modifier 59 is only used if two codes are bundled, specifically if there is a NCCI edits for the two codes. If there is no edit, a modifier 51 is used.  Over-use of modifier 59 is an audit target, so its use should be reserved for this scenario.

And when modifier 59 is used appropriately, a modifier 51 is redundant and unnecessary. Modifier 59 is always placed on a subsequent, lower valued code negating the need for modifier 51.

*This response is based on the best information available as of 11/01/18.

Trauma Laparotomy

Question:

Is there a specific CPT code for trauma laparotomy?

Answer:

No. if an exploratory laparotomy is performed and no injuries are detected and repaired,Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate procedure)is coded. If the retroperitoneum is also explores code 49010Exploration, retroperitoneal area with or without biopsy(s) (separate procedure)instead of 49000. Both codes would never be reported together.

Note that each laparotomy code is designated as a separate procedure, meaning they are bundled if any more complex procedure is perfumed. So if the spleen is removed, the liver repaired, small bowel resections are performed, etc., only those definite procedures would be reported.

*This response is based on the best information available as of 10/18/18.

Coding Mesentery Repair

Question:

Documentation states that the mesentery was repaired as part of where the liver was packed. How is this reported?

Answer:

Code 44850,Suture of mesentery (separate procedure)is designated as a separate procedure and therefore is included in the more comprehensive procedure, the liver packing.  The separate procedure designation means that the procedure is usually a component of a more complex service and is not reported in addition to the more complex service in performed in the same anatomic area.

*This response is based on the best information available as of 10/04/18.