Procedure Converted to Open Approach
There are times when a physician schedules a laparoscopic/arthroscopic/endoscopic, etc. procedure and, due to many various reasons, a physician may elect to convert to an open procedure to ensure the procedure is completed safely for the patient. In these cases, only the open procedure is coded and billed to the insurance company.
The National Correct Coding Initiative Policy Manual for Medicare Services – Effective January 1, 2016 states in chapter 1 General coding policies on page 17:
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 may be reported.
It also states:
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.
Seeing a Pattern
Do you see the pattern? If not, here is one more:
When an endoscopic procedure fails and is converted to another surgical procedure, only the completed surgical procedure may be reported. The endoscopic procedure is not separately reportable with the completed procedure.
Remember, this is a guideline to follow. If there is no NCCI edit, don’t get greedy! The NCCI manual also warns, “the NCCI edits do not contain all bundling combinations because there are so many. The principle policy stated is applicable regardless of whether the selected code pair combination is included in the NCCI tables. A provider should not select laparoscopic and open HCPCS/CPT codes to report because the combination is not included in the NCCI tables.”
NCCI Policy Manual
NCCI PTP Edits