General Surgery Coding Alert

Question: One of our patients had a laparoscopic partial omenectomy. I chose the unlisted code 49329. United Healthcare denied the claim. Was my code choice correct or should I have reported something else?

Missouri Subscriber

Answer: Your code choice is correct, assuming United Healthcare hasn't told you to report another code for this procedure. The unlisted 49329 (Unlisted laparoscopy procedure, abdomen,peritoneum and omentum) is the best code since there is no set CPT code for a laparoscopic omentectomy -- partial or total.

Both CPT and CMS guidelines specifically instruct providers to use an unlisted procedure code when no available code describes the specific procedure your surgeon performs. More specifically, proper coding practice dictates that if the surgeon performs a laparoscopic procedure and there is no laparoscopic code, you should use the unlisted procedure code for that body area. You should not use a comparable open code. If you want to gain appropriate payment for an unlistedprocedure claim, include documentation to compare the reported unlisted procedure to the next closest procedure that appears in CPT. In this case, you would use the open code for an omentectomy (49255, Omentectomy, epiploectomy, resection of omentum [separate procedure]) and have your physician tell the payer whether the laparoscopic procedure involved the same work, less work, or more work.

Important: If your payer wants to have you code this some other way and will give you that information in writing, you should follow their rules.

You also need to consider that partial omentectomies (and complete omentectomies, too) are often bundled into other abdominal procedures and can't be billed separately. If there was another procedure performed during the same session that you are also coding, that could be the reason for the denial as well. In that case, if the surgeon has documented significant additional work, modifier 22 (Increased procedural service) may help you get reimbursed.