Wiki Needing help please

TanBro

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Procedure done was Diagnostic laparoscopy and diagnosis was Dysmenorrhea. While doing the laparoscopy my doc found a couple old staples (noted to be anterior to the uterus and to the right within the peritoneum) and removed them. Also found fluid in the posterior cul-de-sac which was removed and sent to cytology. Usually I would do 49320 for the diagnosis lap but with the extra stuff I'm a little confused. Should I only code 49402? If I do both 49320 and 49402 I would need a modifier is shows. Does anyone have any advice on this?
 
I disagree. 49402 is an OPEN procedure. Based on what you described, this was entirely laparoscopic.
To me, there are 2 options here:
1) Unlisted 49329 Unlisted laparoscopy procedure, abdomen, peritoneum and omentum. You could use 49402 as the comparison code. 49321 might be a better comparison, depending on the amount of work involved.
2) 49320 Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) with modifier -22 for the additional work.

If the staples were a minor part of an exploratory laparotomy, then I would code as option 2 49320-22.
If removing the staples required extensive dissection, adhesiolysis, etc, then I would code as option 1 49329 unlisted.

I am not aware of a laparoscopic removal of peritoneal foreign body code. When there is no corresponding laparoscopic code, you may NOT use an open code instead.
 
I disagree. 49402 is an OPEN procedure. Based on what you described, this was entirely laparoscopic.
To me, there are 2 options here:
1) Unlisted 49329 Unlisted laparoscopy procedure, abdomen, peritoneum and omentum. You could use 49402 as the comparison code. 49321 might be a better comparison, depending on the amount of work involved.
2) 49320 Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) with modifier -22 for the additional work.

If the staples were a minor part of an exploratory laparotomy, then I would code as option 2 49320-22.
If removing the staples required extensive dissection, adhesiolysis, etc, then I would code as option 1 49329 unlisted.

I am not aware of a laparoscopic removal of peritoneal foreign body code. When there is no corresponding laparoscopic code, you may NOT use an open code instead.
This is a very good point. I guess i didn't look at it that way. Thankyou so much for explaining that. I really appreciate it!
 
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