Hi all,
Please help! Medicare pt has Gastric CA, when surgeon went to perform Exploratory Laparoscopy, possible subtotal gastrectomy, peritoneal seedings suspicious for carcinomatosis were identified as well as cholecystitis/cholelithiasis. Surgeon and Oncologist determined the pt will not benefit from gastrectomy as there is no obstruction and this new finding suggests metastatic Gastric CA. A biopsy of peritoneal seeding was taken from R flank and there was also seeding on the acutely inflamed gallbladder and cholecystecomy was also performed. My dilema is, primary dx will be (after confirmation from pathology) peritoneal carcinomatosis, gastric cancer as this is more severe than cholelithiasis. Trouble is an IOC was not done so I can not find a code for peritoneal bx and I am leaning toward 49320 as it was a bx not a resection and the pt was scheduled for exploratory proc poss. resection. This of course will look like bundling with Chole (47562). Do I attach a modifier -59 and wait for denial to submit Op Report as MCR doesn't accept paper claims? Does it not matter, as bx may be considered part of Lap Chole? If I am to only bill for Lap Chole, won't I receive denial because primary dx is peritoneal carcinomatosis, gastric cancer? Please help, any comments are appreciated!