Results 1 to 7 of 7

Laparoscopic surgery converted to Open surgery

  1. #1
    Question Laparoscopic surgery converted to Open surgery
    Medical Coding Books

    When a procedure that was planned as a laparoscopic surgery has to be converted to an open surgery, can they bill both the original surgical code
    (58553- Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g) and the procedure that was actually done (58150- Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s))? In this instance, mod -53 is appended to 58553. Does this modifier make billing these two pairs appropriate? Thanks.

    -Pa Tang

  2. #2
    North Carolina
    If a laparoscopic procedure is converted to an open procedure, only the open procedure may be reported.

    Select NCCI Policy Manual link and open chapter 7-page 10

  3. Default
    I agree you can only bill the open procedure - and also use diagnosis code

  4. #4
    Thanks to you both for your reply. I vaguely remembered from somewhere (maybe while I was still going to school for this) that only the open procedure be coded, but I wasn't able to find any thing about it on paper. Thanks for the link.

  5. #5
    Default AMA Coding Guidelines?

    I know I posted this question awhile ago, but I was wondering if anyone has any documentation or know what AMA's guideline is currently on this issue? I have some documentation (but it's from 2009) about how AMA allows both the open and the converted laparoscopic surgery to be coded and paid. I would like to know if anyone has access to find out AMA's current guideline on this matter. Thanks for the help!

    -Pa Tang

  6. #6
    Hello Pa Tang,

    I agree, with you that it is possible to report both if well documented. It was in a CMS ruling, because if the significant resources were applied to laparoscopic procedure that the laparoscopic procedure was billable with the open. However, locating the ruling is difficult.

  7. #7
    Anchorage, Alaska
    I have a question: what if there was a planned diagnositc laparoscopy and a planned open surgical lap?
    In this article from CMS and the CCI, it states that it is appropriate to use modifier -59 if the the diagnostic procedure immediately precedes the surgical or non-surgical therapeutic procedure and it clearly provides the information needed to decide to continue with the therapeutic procedure and does not constitute services that would be included in the therapeutic procedure.

    I have a patient with a known history of hep-c infection who has a new lesion on his right hepatic lobe immediately adjacent to the inferior vena cava. After examining the liver and confirming the location of the mass and the vnous and arterial flows in the liver via laparoscope, the surgeon performed a laparotomy due to the location of the lesion, the patient's body habitus and a desire to minimize the duration of anesthetic.

    Given this information, what are your views on billing for a diagnostic laparscope and the open lobectomy?

    Thank you for any opinions.

    I think I just found the answer to my question in the CCI manual Chapter 1.C.12 My only problem now is, what is the difference between a scope being the basis for the open procedure and the scope being a scout procedure?
    Last edited by AlaskaCpcCpb; 05-23-2014 at 06:37 PM.

Similar Threads

  1. Replies: 2
    Last Post: 11-04-2016, 01:09 PM
  2. Laparoscopic Pancreas surgery
    By jgray2006 in forum General Surgery
    Replies: 0
    Last Post: 05-12-2014, 12:53 PM
  3. Replies: 1
    Last Post: 04-24-2014, 07:38 AM
  4. Replies: 1
    Last Post: 12-31-2012, 11:14 AM
  5. laparoscopic revison bariatric surgery
    By ShenVallGal in forum General Surgery
    Replies: 1
    Last Post: 03-31-2011, 03:23 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.