General Surgery Coding Alert

Answer: Even with all of the new laparoscopic codes in CPT 2000, there was still not one for laparoscopic excision of lesions of small or large intestine, says Kathleen Mueller, RN, CPC, CCS-P, a coding and reimbursement specialist in Lenzburg, Ill. You would need to use the unlisted laparoscopy code (44209, unlisted laparoscopy procedure, intestine [except rectum], formerly 56399).

When billing an unlisted code, surgeons should remember that an operative note has to be sent with the claim. A cover letter also is necessary to explain why the physician chose to do this procedure laparoscopically as well as how you calculated your fee based on relative value units times a conversion factor. I recommend sending the claim electronically and follow with documentation since this claim will usually be reviewed by the medical director at the carrier and will usually cause a delay in payment. This will avoid getting the notice on your explanation of medical benefits that it was not filed in a timely fashion.

Karen Evans, RN, CPC, CCS-P, a coding and reimbursement specialist in Mount Vernon, Wash., adds that if 44120 (enterectomy, resection of small intestine; single resection and anastomosis) were performed laparoscopically, code 44202 (laparoscopy, surgical; intestinal resection, with anastomosis [intra or extracorporeal], formerly 56348) would be used.