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Open code vs lap unlisted code

  1. #1
    Location
    Johnson City
    Posts
    202
    Default Open code vs lap unlisted code
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    I am wondering what the consensus is on this situation. I often can not find the laparoscopic code that I'm looking for and often have to opt for an unlisted. Example: Surgeon performs laparoscopic liver biospy wedge. The only code for wedge biopsy of the liver is code 47100, which is open. The codes for Laparoscopic liver bx do not accurately describe a wedge bx. therefore code 47379 is my option. I prefer not to use unlisted codes, carriers do not price appropriately, and the delay in processing of the claim is annoying. I heard that some coders choose to bill the open code with mod 52indicating this procedure is reduced. ie. not open, laparoscopic. What do you think about this practice.
    Thanks,
    Melissa-CPC

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default 47100 -52
    You certainly could code it as 47100 with -52 modifier.

    However, you should be able to defend your position on an unlisted code, as long as you equate it appropriately to the open procedure and price it correctly. I know it's a hassle, but we do have success with this.

    Consider making these arranagments with the carriers IN ADVANCE. Get your physician to help you draft a letter explaining what the procedure entails and why you believe it should be reimbursed at "x" level. If you get the carrier's buy-in first, especially if it's for a procedure that you'll be doing with some regularity, that should serve you well.

    F Tessa Bartels, CPC, CPC-E/M
    Last edited by FTessaBartels; 02-16-2009 at 01:48 PM.

  3. #3
    Location
    Johnson City
    Posts
    202
    Default
    Thanks!!

  4. #4
    Default
    What if the physician performs a core needle biopsy during a lap chole but he makes a separate abdominal incision to place the biopsy needle through? Could we code this as 47000-59 or stay with +47001?

    Thanks!!
    Mary Beth Gord, CPC

  5. #5
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    47001 is an add on code to hundreds of lap codes, including 47562/47563. I have previously posted the list under one of the forums (dont ask me which one..pleaseeeeee...lol) but its here somewhere

    Mary, CPC,COSC

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