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Modifier 53-I have a patient

  1. #1
    Default Modifier 53-I have a patient
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    I have a patient who had the following procedure done:

    1. Attempted hand-assisted laparoscopic approach, with conversion to open left colon resection.
    2. Takedown splenic flexure

    I coded 44140 and 44139, but am wondering if it would be appropriate to add 44204 with a modifier 53? The patient has BCBS. I know with Medicare you code the final procedure if it is a lap converted to open. I cannot find any coding rules out there that address this. Any help would be appreciated.

  2. #2
    Thumbs up
    The appropriate codes would be 44204, 44213 For Above mentioned procedure.

  3. #3
    BCBS will deny the Lap as bundled into the open procedure. I 've just received a denial for this same thing.
    adrianne, cpc

  4. #4
    Why would I use 44204 and 44213 since the procedure ended up being done open after laparoscopy failed?

  5. Default
    44140 & 44139 would be the correct procedures. When converting from laparoscopic to open procedures, you would only charge the open procedures.


  6. #6
    I was just reading something today on 'convertion-to-open'coding. Granted, the following info was obtained from a urology publication, but I think the info applies. It says that unlike Medicare, the AMA, which publishes the CPT Manual, allows you to bill both the laparoscopic and open procedures. However, you have to report the failed laparoscopic procedure with modifier 52 (reduced services). CPT guidelines state: "When the specific circumstances for the conversion of the laparoscopic procedure to an open procedure have been determined, it is then appropriate to report the code for the 'attempted' laparoscopic procedure with the appropriate modifier appended. The code for the open procedure is reported as the primary procedure with the modified laparoscopic code reported as a secondary procedure."

    Of course, BCBS have their own edits. But maybe you can try sending your claim with the operative report and/or get the payer's policy in writing. Hope this was useful.

    Zaida, CPC

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