General Surgery Coding Alert

Often, coders rely on the CPT index when billing for reopening a laparotomy. The index directs them to 49002 (reopening of recent laparotomy). But under certain circumstances, they can use 35840 (exploration for post-operative hemorrhage, thrombosis or infection; abdomen) for the procedure and receive a slightly
higher reimbursement.

Using 35840Cardiovascular Section

Some coders maintain that if the laparotomy is being reopened because of bleeding or infection, the correct code should be 35840. Not only does it denote a higher level of specificity, they say, it also reimburses at a slightly higher rate.

For example, a patient with a history of diverticulosis (562.10) sees a general surgeon complaining of abdominal pain, and the surgeon performs a colonoscopy, which shows the patient has inflamed, irritated intestines. The surgeon decides to wait and watch, but two weeks later, the patient shows up in the emergency room doubled over in pain. When the surgeon is called in, he decides to perform an exploratory laparotomy, discovers that the intestines are very inflamed and showing signs of severe disease.

Based on these findings, the surgeon performs a colon resection (44140, colectomy, partial; with anastomosis).

Note: The exploratory laparatomy would be bundled into the colon resection.

Three days later, however, the patient complains about pain in the operative site and is running a fever. There also is redness around the wound. Consequently, the surgeon reopens the laparotomy to stop the infection.

Some coders may not use 35840 in this scenario because they are unfamiliar with the CPT manual, expert coders say.

Code 35840 is in the cardiovascular section, which at first glance would not seem to apply in the scenario outlined above. Instead, they may refer to the digestive system section because the laparotomy was performed on the intestines.

Coders dont go to the cardiovascular section because they look in the index, which takes them straight to the digestive system, says Kathy Zmuda, CPC, lead inpatient coder for CIGNA Healthcare in Phoenix, AZ. In fact, if you look up laparotomy in the CPT index, you will find 49002 in the exploration subsection, but no reference to 35840.

Barbara Cobuzzi, MBA, CPC, CHBME, president of Cash Flow Solutions, a physician reimbursement consulting firm in Lakewood, NJ, notes that 35840 is more specific and reimburses at a slightly higher rate. The reason for reopening the recent laparotomy is sometimes ignored and could be a vascular-related thing, such as a post-operative infection, thrombosis or hemorrhaging.

The lesson in all this, Cobuzzi says, is that coders shouldnt pigeonhole themselves in their own area of the CPT book.

What About 49002?

But not all coding experts agree that 35840 should be used in scenarios like the one above. Susan [...]