General Surgery Coding Alert

Take what you’ve learned in “3 Tips Demonstrate Key Terms You Need to Know for Splenectomy Coding” and try your hand at coding the following case:

A 12-year-old female complains of abdominal pain in the left upper quadrant and exhibits blurred vision and nausea after being involved in a car wreck. The surgeon performs an exploratory laparotomy and determines that the spleen and a portion of the small intestine are injured. Noting extensive splenic tears, the surgeon proceeds to bluntly dissect the spleen and remove it, ligating gastric arteries and clamping the splenic pedicle to control bleeding. Noting a crushed section of small intestine and extensive bleeding, the surgeon also resects the damaged section and anastomoses the segments before closing.

Comply With Bundling Rules

The surgeon performs an exploratory laparotomy, a splenectomy, and an enterectomy in this case. Check your coding efforts against the experts for this scenario.

The correct code for the enterectomy is 44120 (Enterectomy, resection of small intestine; single resection and anastomosis).

Two choices: The total splenectomy in this case is an open procedure, which leaves you with two code choices:

• 38100 (Splenectomy; total (separate procedure))
• +38102 (… total, en bloc for extensive disease, in conjunction with other procedure (List in addition to code for primary procedure))

“You should code the splenectomy in this case as +38102, because the surgeon performs the spleen resection for extensive injuries in the same anatomic area that involve both the spleen and a portion of the small intestine,” says Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, billing specialty subject matter expert at Kareo in Irvine, Calif.

In fact, The National Correct Coding Initiative (NCCI) bundles 38100 as a column 2 code for 44120. Although a modifier is allowed to override the edit pair, that’s not appropriate in this case because the procedures are at the same anatomic site, and CPT^® provides the add-on code to account for scenarios such as this.

Laparotomy: Although the op note mentions that the surgeon performed an exploratory laparotomy, you should not report 49000 (Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate procedure)) in this case.

“The laparotomy is an integral part of both the splenectomy and the enterectomy,” Joy says.

Edit pairs: NCCI confirms that understanding by bundling 49000 as a column 2 code with both 44120 and +38102. The edit pairs show a modifier indicator of “0,” meaning that you cannot override the edit pair under any circumstances.