General Surgery Coding Alert

Question: Our general surgeon performed a laparoscopic cholecystectomy with cholangiography. The surgeon noted that the gallbladder had lots of stones that intermingled with the small bowel loops and had extensive adhesions to the colon, which caused an open repair of injury to the colon. What is the correct coding for this case; can we bill for the colon repair with a separate code? 

Nebraska Subscriber

Answer: You should report the primary procedure as 47563 (Laparoscopy, surgical; cholecystectomy with cholangiography). 

If the surgeon’s documentation clearly demonstrates that the creation of the intestinal hole was due to patient disease and not an inadvertent medical error, you should also list 44604 (Suture of large intestine [colorrhaphy] for perforated ulcer, diverticulum, wound, injury or rupture [single or multiple perforations]; without colostomy) for the colon repair. 

Additionally, if the surgeon documents that the lap cholecystectomy required at least 150 percent of the normal time for the procedure due to the gallbladder stones and excessive colon adhesions, then you might also consider billing the 47563 with modifier 22 (Increased procedural services). You may use the modifier even if you report the separate code for the colon repair, as long as the documented extra time and work relates just to the lap cholecystectomy, not to the repair that code 44604 describes.