General Surgery Coding Alert

Question: Our surgeon started out doing a laparoscopic cholecystectomy with cholangiogram, but decided to open (without having removed the gallbladder)-to do bile duct exploration.-What code should I use to cover the bile duct exploration?-Would 47610 cover everything?

New York Subscriber

Answer: Yes, you would only report 47610 (Cholecystectomy with exploration of common duct) for an open cholecystectomy with exploration of the common duct and cholangiogram. The national Correct Coding Initiative (CCI) bundles 47605 (Cholecystectomy; with cholangiography) into 47610. The edit includes a "0" modifier indicator, meaning that you may never override them. Payers will always include the work involved in cholangiography in exploration of the common ducts.

If during a laparoscopic cholecystectomy, the surgeon must convert to an open surgery due to inflammation, extensive adhesions or other complications -- as in this case -- you should report the open procedure only, according to CPT and CMS guidelines. In other words, you would not report a "failed" laparoscopic procedure, such as 47564-53 (Laparoscopy, surgical; cholecystectomy with exploration of common duct; discontinued procedure) in addition to the open code.

----- Finally, when the surgeon converts a lap chole to an open procedure, be sure to include V64.41 (Laparoscopic surgical procedure converted to open procedure) as a secondary diagnosis. Using V64.41 does not affect the primary diagnosis (for instance, 575.0, Acute cholecystitis).

- ---- You should also use additional diagnosis codes to describe the conditions that lead to the decision to change from the laparoscopic to the open approach. These conditions could include adhesions, abscess or others.