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Laparoscopic cholecystectomy??

  1. Default Laparoscopic cholecystectomy??
    Medical Coding Books
    I'm billing for the above using cpt 47562 but don't know if I should bill separately for the laparoscopic mesenteric biopsy, and if so with which cpt code? thanks


    DX: Biliary colic and mesenteric ascites
    Procedures: Laparoscopic cholecystectomy and laparoscopic mesenteric biopsy

    INDICATIONS:
    The patient is a 58 year old gentleman who comes in with biliary colic and mesenteric ascites. He was brought to the OR for laparoscopic cholecystectomy and biopsy of the mesentery.

    FINDINGS AT TIME OF SURGERY:
    He had several areas of mesenteric ascites. In the retroperitoneum, no obvious lymphadenopathy was noted within the small bowel mesentery or colonic mesentery. The area of this mesenteric ascites was biopsied.

    OPERATIVE PROCEDURE:
    The patient was brought to the operating room and placed in supine position. General endotracheal anesthesia was established. Preoperative antibiotics were given. His abdomen was prepped and draped in the usual sterile fashion. The incision was made. Infraumbilical dissection was carried down through the layers until the fascia was picked up and incised. The fascia was incised. A #11 mm port was inserted. The pneumoperitoneum was achieved under direct vision. Two right sided 5 mm port was placed and one left sided 5 mm port was placed. A diagnostic laparoscopy was carried out and the small bowel was inspected. The retroperitoneum was inspected. There was sclerosing region in the retroperitoneum. This was biopsied using cautery. After this was removed through EndoCatch, our attention was turned towards the gallbladder. The terminal closed dissected free. The cystic duct and cystic artery were each identified. They were clipped and transected. The gallbladder was then removed using Bovie cautery and placed in an EndoCatch brought out through the umbilicus. His liver bed was inspected. The biopsy bed was inspected. Pictures were taken. All the ports were removed under direct vision. The umbilical fascia was closed using figure of eight 0 Vicryl suture. All other wounds were infiltrated with Marcaine. The skin was closed using 4 0Monocryl subcuticular followed by Steri Strips and bandages. The patient tolerated the procedure well, was extubated, and brought to the PACU in stable condition.

  2. Default
    any takers on this one?

  3. #3
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    Tacoma, WA
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    Default
    Quote Originally Posted by BFAITHFUL View Post
    I'm billing for the above using cpt 47562 but don't know if I should bill separately for the laparoscopic mesenteric biopsy, and if so with which cpt code? thanks


    DX: Biliary colic and mesenteric ascites
    Procedures: Laparoscopic cholecystectomy and laparoscopic mesenteric biopsy

    INDICATIONS:
    The patient is a 58 year old gentleman who comes in with biliary colic and mesenteric ascites. He was brought to the OR for laparoscopic cholecystectomy and biopsy of the mesentery.

    FINDINGS AT TIME OF SURGERY:
    He had several areas of mesenteric ascites. In the retroperitoneum, no obvious lymphadenopathy was noted within the small bowel mesentery or colonic mesentery. The area of this mesenteric ascites was biopsied.

    OPERATIVE PROCEDURE:
    The patient was brought to the operating room and placed in supine position. General endotracheal anesthesia was established. Preoperative antibiotics were given. His abdomen was prepped and draped in the usual sterile fashion. The incision was made. Infraumbilical dissection was carried down through the layers until the fascia was picked up and incised. The fascia was incised. A #11 mm port was inserted. The pneumoperitoneum was achieved under direct vision. Two right sided 5 mm port was placed and one left sided 5 mm port was placed. A diagnostic laparoscopy was carried out and the small bowel was inspected. The retroperitoneum was inspected. There was sclerosing region in the retroperitoneum. This was biopsied using cautery. After this was removed through EndoCatch, our attention was turned towards the gallbladder. The terminal closed dissected free. The cystic duct and cystic artery were each identified. They were clipped and transected. The gallbladder was then removed using Bovie cautery and placed in an EndoCatch brought out through the umbilicus. His liver bed was inspected. The biopsy bed was inspected. Pictures were taken. All the ports were removed under direct vision. The umbilical fascia was closed using figure of eight 0 Vicryl suture. All other wounds were infiltrated with Marcaine. The skin was closed using 4 0Monocryl subcuticular followed by Steri Strips and bandages. The patient tolerated the procedure well, was extubated, and brought to the PACU in stable condition.
    I don't really see an additional code, the biopsy was done as a part of the gallbladder surgery. You could append modifier 22 and send with the op report for the additional work but you may not get more for this procedure.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  4. Default
    thanks .... I was being told I can bill 38570 but I disagree.

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