Unlisted laparoscopic procedures

kenbeckman

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I am seeing an increasing number of procedures performed laparoscopically (and arthroscopically) for which there is no code under the Laparoscopy (arthroscopic) section of the manual. However, there is a specific matched code for the procedure elsewhere that does not specify 'open'. I get claims for this procedure in both manners.
If the CPT manual does not specify 'open' but does not list the procedure under the laparoscopy section of the manual, is it correct to use the specific code rather than unlisted laparoscopic code?
Example: During a laparoscopic procedure, the surgeon also performed a partial omentectomy. The surgeon billed using CPT 49255-51, the surgical assistant billed using 49329-80-51.
My feeling is that from a description viewpoint the surgeon is correct since the CPT code 49255 does not specify 'open', but I also know that the RVUs for that code were determined when it was only performed in an open manner. So from a RVU viewpoint, the assistant is correct.
The payment issue makes the problem worse. Like most payers, the CPT code 49255 falls under a fee schedule and the unlisted code falls under a percent discount off charges. So the procedure that required less work but is unlisted typically ends up with a higher reimbursement that the higher RVU specific code!
 

Lujanwj

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CPT® Assistant, February 2006
Coding Consultation: Questions and Answers
Laparoscopic Procedures
Question: If a laparoscopic procedure is performed but there is not a CPT code that accurately describes the procedure, would it be appropriate to report the corresponding open procedure if one exists?

AMA Comment: If a laparoscopic procedure is performed but no CPT code accurately describes the laparoscopic procedure, the corresponding open procedure code should not be reported. Instead, the appropriate unlisted laparoscopic code should be reported. An open procedure code should never be reported to describe a procedure that was performed laparoscopically.

________

AMA's - Principles of CPT Coding 6th Edition p.171

General guidelines for coding endoscopic procedures are as follows:

1. Look up endoscopy/ laparoscopy/arthroscopy in the index and locate the organ or system being examined or treated with a scope.
2. Look at the codes in that system or organ section to find an endoscopy or laparoscopy heading.
3. If there is no endoscopy/laparoscopy/arthroscopy heading in that section, look for a code with a descriptor that includes a suffix "-oscopy," and describes the procedure petformed.
4. If there is no heading of endoscopy/laparoscopy/arthroscopy or there is no specific code describing the use of an endoscope in its descriptor, one may be certain the codes described in that section are open surgical procedures and should not be used to report a procedure using an endoscopic approach.
5. Clarify with the physician that the procedure was performed with an endoscope/laparoscope/arthroscope.
6. If it is determined there is no specific code for the endoscopic/ laparoscopic/arthroscopic procedure one is attempting to code, use the unlisted procedure laparoscopy/endoscopy/arthroscopy code to report the procedure. In this case, a copy of the operative report should be submitted to the insurance company when the claim is filed.
 
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