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General Surgery Coding Alert

You Be the Coder:

Intraoperative Consult Denied

Published on Wed May 01, 2002

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

 Question: An ob/gyn performing a laparoscopic bilateral fulguration of the fallopian tubes lacerated the patient's intestine as he inserted the trocar. Our general surgeon examined her abdomen and pelvis and discovered that her mesentery was lacerated. He suggested that she be admitted to a nearby hospital for observation for a few days. Our general surgeon continued to look in on the patient. The carrier paid for the hospital visit; however, the original intraoperative consultation was denied. Can we file a corrected claim and change the consult to an exploratory laparoscopy?
 

   Florida Subscriber

 
Answer: The general surgeon can report the exploratory laparoscopy (49320) only if it is documented in the operative report. If the laparoscopy was noted in the operative report, it is actually incorrect not to report it.
 
Medicare carriers (but not most private or Medicaid payers) may pay for both the consultation and the exploratory laparoscopy with modifier -57 (Decision for surgery) appended to the consultation to indicate that it led to the decision to perform the exploratory laparoscopy.
 
If the surgeon repaired the lacerated mesentery, however, 49320 should not be billed; instead, 44850 (Suture of mesentery [separate procedure]) should be reported. Modifier -57 would still be required on the appropriate consultation code.
 
Note that the intraoperative consult may have been denied because:

1. The consultation code was incorrect. CPT includes two types of inpatient consultations (initial and follow-up) and one outpatient consultation. If the surgeon billed for an outpatient consult by mistake, the carrier may deny the claim because the place of service (inpatient hospital) does not match the CPT code.

2. The first inpatient visit was performed on the same day as the consultation. If the surgeon had the patient admitted the same day the procedure was performed and billed both E/M services on the same day, one service will likely be denied because two E/M codes may not be billed by the same physician for the same patient on the same day. The only exception is critical care, which may be billed in addition to another E/M code, such as an admission or a consult.

3. The carrier made an error. Carriers often deny claims that are coded correctly. These claims should be resubmitted and, if necessary, appealed to the highest level. In most cases, carriers will correct these errors without too much fuss unless there is a policy that justifies the denial.

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