Laparoscopic-to-open Surgery Coding
When a procedure begins by laparoscopic approach, but for any reason must be converted (and completed) by open approach, you should report only the open approach. As described in chapter 1 of the National Correct Coding Initiative (NCCI) Policy Manual:
If a procedure utilizing one approach fails and is converted to a procedure utilizing a different approach, only the completed procedure may be reported. For example, if a laparoscopic hysterectomy is converted to an open hysterectomy, only the open hysterectomy procedure code may be reported.
If a planned laparoscopic procedure fails and is converted to an open procedure, only the open procedure may be reported.
Nor should you attempt to report a diagnostic laparoscopy in lieu of the failed surgical endoscopy. The Policy Manual further explains:
If a laparoscopic procedure fails and is converted to an open procedure, the physician should not report a diagnostic laparoscopy in lieu of the failed laparoscopic procedure. For example, if a laparoscopic cholecystectomy is converted to an open cholecystectomy, the physician should not report the failed laparoscopic cholecystectomy nor a diagnostic laparoscopy.
If a diagnostic laparoscopy results in an open surgical procedure, however, you may report the diagnostic/exploratory laparoscopy separately with modifier 58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period appended. Per the Policy Manual:
If a diagnostic endoscopy is the basis for and precedes an open procedure, the diagnostic endoscopy is separately reportable with modifier 58. However, the medical record must document the medical reasonableness and necessity for the diagnostic endoscopy. A scout endoscopy to assess anatomic landmarks and extent of disease is not separately reportable with an open procedure.
Note that the same rule does not apply if a diagnostic laparoscopy leads to a surgical laparoscopy at the same location. The Policy Manual dictates:
Diagnostic endoscopy is never separately reportable with another endoscopic procedure of the same organ(s) when performed at the same patient encounter. Similarly, diagnostic laparoscopy is never separately reportable with a surgical laparoscopic procedure of the same body cavity when performed at the same patient encounter.
A final point: When a procedure begins by laparoscopic approach, but is completed by open approach, you should report an additional diagnosis of V64.41 Laparoscopic surgical procedure converted to open procedure to describe this circumstance.