General Surgery Coding Alert

Questions: The surgeon performed a laparoscopic cholecystectomy-and a liver biopsy at the same time. The biopsy occurs laparoscopically through the same incision as the lap chole. How should I report the liver biopsy? Illinois Subscriber Answer: Because this is a laparoscopic procedure, the obvious liver biopsy codes do not apply. Codes 47000 (Biopsy of liver, needle; percutaneous) and +47001 (- when done for indicated purpose at time of other major procedure) are both through-the-skin procedures, and 47100 (Biopsy of liver, wedge) describes an open liver approach. Frustratingly, the only laparoscopy codes in CPT's "liver" portion, 47370-47371, describe ablation of tumors and make no room for biopsy. This leaves only 47379 (Unlisted laparoscopic procedure, liver). There is a better choice: 49321 (Laparoscopy, surgical; with biopsy [single or multiple]). Although this code does not specify "liver," it falls under the general "laparoscopy" portion of CPT and clearly describes the procedure your surgeon performed. As CPT guidelines specify, you can (and should) save yourself the hassles of reporting an unlisted-procedure code unless "no specific code exists" to describe the procedure you wish to report. There are no bundling issues with 49321 and any of the laparoscopic cholecystectomy codes 47562-47564, so you should have no difficulty reporting both procedures (although multiple-procedure payment reductions will apply).