Minilap hysterectomy - open or lap code?

Jill Winfree

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I am having difficulty finding a definitive source regarding minilaparotomy coding.

58570-58573 vs 58150

Surgeon is performing laparoscopic/robotic da vinci hysterectomy for an oncology Dx and the organs/tissues cannot be removed vaginally. Instead, a port/arm site incision is extended, the surgeon's hand enters the abdomen to remove the organs/tissues through the extended abdominal incision. All preparation for removal of the tissues was performed via laparoscope/robot.

Per ACOG link below, lap codes 58570, 58571, 58572, 58573 are appropriate if tissues are removed vaginally or via abdominal incision. However, many other blogs and coder posts suggest using the open code as abdomen was opened via an incision and the actual manipulation of the organs with hands occurred internally. Another suggests selecting based on whichever approach was used for the majority of the case. I cannot find anything addressing this specific question in CPT Assistant.

http://www.acog.org/About-ACOG/ACOG-Departments/Coding/Coding-Laparoscopic-Hysterectomy-Procedures

Thoughts? Any references other than the ACOG link above? I have multiple op reports, but above is the key information that does not change. Thank you!
 
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I believe this should be coded as open. It doesn't matter how much work was done laparoscopically. If the laparoscopic approach fails and an incision is made to carry out the procedure, then it becomes open.
 
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