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August 21, 2006
Laparoscopy is an examination of the abdominal cavity using an endoscope that allows for direct visual inspection for diagnosis and treatment of abnormalities in the abdomen. A fiber optic tube is inserted into a small incision at the bottom of the navel. Carbon dioxide gas is used to inflate the abdomen for easier visualization of the organs. One or two additional incisions may be required to provide surgical access to the area. Intraoperative risks, postoperative complications, length of the hospital stay, and the cost of treatment are generally decreased with laparoscopic procedures as compared with the traditional open procedures. Diagnostic Laparoscopy However, if a more definitive procedure is done at the same time, a code for the laparoscopy is not assigned. Instead, the code for the more specific procedure performed is assigned with no additional code for the laparoscopy. For example, a patient is admitted for laparoscopic biopsy of the peritoneum. Assign code 54.24 for this procedure. The laparoscopic approach is not coded. However, if an exploratory procedure is performed along with a biopsy, a code for both the biopsy and exploratory procedure is assigned. For example, a patient underwent an exploratory thoracoscopy and a pleural biopsy. The surgeon states that the thoracoscopy involved more than just the operative approach. Therefore, AHA Coding Clinic for ICD-9-CM advises to code both procedures (34.24 and 34.21) [2002, third quarter, page 27]. Surgical Approach Some healthcare facilities may wish to capture the use of a scope for data information purposes. However, assigning the scope code as an additional procedure may affect the diagnosis-related group assignment. The decision to assign the scope code is up to each individual hospital’s policy. If the laparoscopic procedure is not successful and has to be converted to an open approach, then only a code for the open procedure will be assigned. Do not assign a code for the laparoscopy. In addition, assign code V64.41, Laparoscopic surgical procedure converted to open procedure, as a secondary diagnosis. There are also codes available for other scope procedures converted to an open procedure, such as the following: • V64.42, Thoracoscopic surgical procedure converted to open procedure • V64.43, Arthroscopic surgical procedure converted to open procedure Morbid Obesity Procedures • 44.38, Laparoscopic gastroenterostomy • 44.68, Laparoscopic gastroplasty • 44.95, Laparoscopic gastric restrictive procedure • 44.96, Laparoscopic revision of gastric restrictive
procedure • 44.97, Laparoscopic removal of gastric restrictive
device(s) • 44.98, (Laparoscopic) adjustment of size of
adjustable gastric restrictive device In addition, laparoscopic Roux-en-Y gastroenterostomy/gastrojejunostomy is now indexed to code 44.38 and Roux-en-Y gastroenterostomy/gastrojejunostomy is now indexed to code 44.39. Coding and sequencing for laparoscopy are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding. — This information was prepared by Audrey
Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a
business of 3M Health Information Systems, a supplier of coding and
classification systems to nearly 5,000 healthcare providers. The company
and its representatives do not assume any responsibility for reimbursement
decisions or claims denials made by providers or payors as the result
of the misuse of this coding information. More information about 3M
Health Information Systems is available at www.3mhis.com
or by calling 800-367-2447.
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