General Surgery Coding Alert

Laparoscopic biopsy requires an -unlisted procedure- CPT If you-re having problems getting your surgeon paid for liver biopsies he performs at the same time as other abdominal procedures, the culprit could be your diagnosis coding. Here's what you need to know to claim the reimbursement you-ve got coming. Master CPT Coding with One Rule When selecting an appropriate CPT code for liver biopsy, first consider: Did the liver biopsy occur alone or at the same time as another abdominal procedure? If the surgeon performs the biopsy without another major abdominal procedure(s), you will report either 47000 (Biopsy of liver, needle; percutaneous) or 47100 (Biopsy of liver, wedge), depending on whether the surgeon obtains the sample by passing the needle through the abdominal or thoracic wall into the liver (percutaneous), or by open surgical excision (wedge), confirms Carrie Young, CPC, coding unit manager at Springfield Clinic LLC in Springfield, Ill. Terminology watch: You may also see surgeons document a needle biopsy (47000) as a "needle core" or "core" biopsy, Young advises. Keep an Eye Out for Imaging Often, the surgeon will use imaging guidance when introducing a needle to collect a liver specimen (47000). Imaging choices include 76942 (Ultrasonic guidance for needle placement-), 77002 (Fluoroscopic guidance for needle placement-), 77012 (Computed tomography guidance for needle placement-) and 77021 (Magnetic resonance guidance for needle placement-). If your surgeon dictates and signs the official report for the imaging service, you may be able to report the imaging separately using the appropriate CPT code with modifier 26 (Professional component) appended. Note that in most cases, however, a facility radiologist, rather than the surgeon, will report the imaging service. Learn more: For additional information on coding for imaging services, see Reader Question "Report Fluoro Codes With Caution," on page 95 of this issue. If the surgeon performs the liver biopsy at the same time as any other major abdominal surgery, however, you should report add-on code +47001 (Biopsy of liver, needle; percutaneous, when done for indicated purpose at time of other major procedure [list separately in addition to code for primary procedure]). Note: You will use +47001 only in conjunction with a separate, primary procedure code. The surgeon obtains the liver sample using the cutting needle while he is in the abdominal cavity to perform another procedure. Special exception: If the surgeon obtains the liver sample using the laparoscope, you should report 47379 (Unlisted laparoscopic procedure, liver), regardless of other circumstances, reminds Tami Atkins, CPC-H, audit review coordinator with Surgical Care Affiliates in Greensboro, NC. Three More Codes Can Describe Liver Bx. In addition to 47000, +47001 and 47100, CPT contains three other codes that may describe liver biopsy as part of an overall surgical [...]