General Surgery Coding Alert

Question: My surgeon's op note says that he used a Veress needle to create a pneumoperitoneum. Then he performed laparoscopic enterolysis for restrictive intestinal adhesions. Can I code both the pneumoperitoneum procedure and the enterolysis?

Texas Subscriber

Answer: You should report the surgeon's work in this case as 44180 (Laparoscopy, surgical, enterolysis [freeing of intestinal adhesion] [separate procedure]). You should not bill any other services, including the surgeon's induction of pneumoperitoneum.

Here's why: Although CPT provides a code to describe the introduction of air into the abdominal cavity (49400, Injection of air or contrast into peritoneal cavity [separate procedure]), surgeons routinely perform this step as part of a laparoscopic procedure. The surgeon must "inflate" the abdomen to create space to visualize the surgical field and move instruments unobstructed.

Because pneumoperitoneum is the first step for a typical laparoscopy, and the code for the service specifies "separate procedure," you should not code 49400 in addition to other codes for laparoscopy.