Wiki Laparoscopic peritoneal biopsy with modified luna

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jilly78

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My physician performed a laparoscopic peritoneal biopsy with a modified luna. I was wondering if I am able to code for the laparoscopic biopsy separate from the luna? Any help would be appreciated.

Jill
 
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nielynco said:
I would need to see the op note for this in order to assist.
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Op report states:

A 5mm trocar was introduced into e mid umbilical incision using anterior lift technique, followed by laparoscope which revealed safe penetration. Pneumoperitoneum with 2 L CO2 gas was carried out followed by a second suprapubic trocar introduced under direct visualization. Inspection revealed normal tubes and ovaries. Tubes were traced out to the fimbriated portion and ovaries were evaluated on both surfaces appeared shiny and free of any disease. A small follicle was present on the patient's right ovary. The uterosacral ligaments were inspected. No evidence of the endometriosis or any other lesions were identified. There was a large amount of pelvic congestion in the patient's left lower adnexa and pelvic sidewall consistent with pelvic congestion syndrome and then dilated veins. A right uterosacral ligament biopsy was obtained of the peritoneum near the cervical attachment medially and this was then cauterized using the LigaSure device to perform a modified laparoscopic uterosacral nerve ablation or LUNA to prevent pelvic pain. The pneumoperitoneum was deflated. The incision was closed.
 
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jilly78 said:
Op report states:

A 5mm trocar was introduced into e mid umbilical incision using anterior lift technique, followed by laparoscope which revealed safe penetration. Pneumoperitoneum with 2 L CO2 gas was carried out followed by a second suprapubic trocar introduced under direct visualization. Inspection revealed normal tubes and ovaries. Tubes were traced out to the fimbriated portion and ovaries were evaluated on both surfaces appeared shiny and free of any disease. A small follicle was present on the patient's right ovary. The uterosacral ligaments were inspected. No evidence of the endometriosis or any other lesions were identified. There was a large amount of pelvic congestion in the patient's left lower adnexa and pelvic sidewall consistent with pelvic congestion syndrome and then dilated veins. A right uterosacral ligament biopsy was obtained of the peritoneum near the cervical attachment medially and this was then cauterized using the LigaSure device to perform a modified laparoscopic uterosacral nerve ablation or LUNA to prevent pelvic pain. The pneumoperitoneum was deflated. The incision was closed.
Click to expand...
Thanks for this. First, it is obvious that the initial procedure is represented by 49321 since he performed an actual biopsy (rather than just collecting fluids to send off the lab which would be done with 49320). But the issue is the LUNA. This procedure is considered experimental by every payer I have ever dealt with and in addition, there is no laparoscopic code for this procedure. Sometimes, they will cover it if the provider documents the nature of the patient's intractable pelvic pain, outling what has been tried and did not work. The OB/Gyn Coding Alert has done many articles on this topic and one of the more recent ones addressing this issue (using an unlisted code for this and how to calculate a comparison code) was published in May 2022 (4 Tips Will Help You Succeed Capturing Unlisted Procedure Payment, Key: Referencing the nearest equivalent CPT® code).
 
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