General Surgery Coding Alert

Question: The surgeon performed an exploratory laparotomy and wedge biopsy of the liver. She excised the mass and sent it to pathology, and it returned positive. How should I code this?


Georgia Subscriber

 
Answer: You should report 47100 (Biopsy of liver, wedge). Unlike other liver biopsies, the procedure described by 47100 is considered an excision because the surgeon takes a wedge of liver and then sutures the excised edges to prevent bleeding.

You may have some difficulty obtaining wedge biopsy payment if the surgeon undertakes the procedure during the same session as another abdominal procedure. Some carriers routinely bundle biopsies with more extensive procedures.

To fight inappropriate bundling, link different diagnosis codes to the primary procedure and the wedge biopsy.

This means surgeons should wait until the pathology report returns before noting the appropriate diagnosis code for the biopsy. Because, in your case, the biopsy returned positive, you will use either 155.0 (for a primary liver neoplasm) or 197.7 (for a secondary liver carcinoma) as the diagnosis for the biopsy.

If the biopsy did not show cancer, you should instead report the result of the biopsy or the sign or symptom that prompted the surgeon to take the biopsy.

For example, if the surgeon discovers a nodule on the edge of the liver as he is removing the patient's gallbladder and decides to perform a wedge biopsy, you should report the result of the biopsy (for instance, 211.5, Benign neoplasm of liver and biliary passages, or 572.0, Abscess of liver). Alternatively, you should report 573.8 (Other specified disorders of liver) for the liver nodule if the pathology report indicates normal liver tissue.