tci General Surgery Coding Alert - 2003 Issue 5

Reader Question: Report Open Procedure When Converting

Question: How should I code if the physician must convert a laparoscopic cholecystectomy to an open cholecystectomy? Maine SubscriberAnswer: Medicare guidelines specify that you should report the open procedure only when converting from a laparoscopic cholecystectomy. In addition, you should append a secondary diagnosis of V64.4 (Laparoscopic surgical procedure converted to open procedure) to further describe the procedure's circumstances.If the surgeon performed a significant portion of the procedure laparoscopically before converting to the open procedure, you may append modifier -22 (Unusual procedural services) and increase your fee. But be certain to have sufficient documentation supporting your claim...

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