CPT Coding guidelines for open abdomen procedure

CPT Coding guidelines for open abdomen procedure

The purpose of this surgery is to explore the entire abdominal cavity to find the source of the problem. If the surgeon can identify the problem, any necessary surgical treatment can take place right away.

2. Can we code Exploration of laparotomy procedure with open abdominal procedure?

An exploratory laparotomy (CPT code 49000) is not separately reportable with an open abdominal procedure.

When and why is an exploratory lap performed?

https://www.medicalcodingcorner.com/digestive-system-coding/cpt-2023/

1. have serious or long-term abdominal symptoms that defy diagnosis.
2. have had major abdominal trauma and there’s no time for other testing.
3. are not a good candidate for laparoscopic surgery.

NCCI edit guidelines: Advantages of NCCI edit to avoid the error. It leads to accuracy of coding 

OPEN ABDOMEN PROCEDURE 44005 improve coding knowledge 

1.  A cholecystectomy CPT code is not separately reportable with a hepatectomy CPT code.
2. A medically necessary appendectomy may be reported separately. However, an incidental appendectomy of a normal appendix during another abdominal procedure is not separately reportable.
3. If a hernia repair is performed at the site of an incision for an open or laparoscopic abdominal procedure, the hernia repair (e.g., CPT codes available 15778, 49591-49596, 49613-49618, 49621-49623) is not separately reportable. The hernia repair is separately reportable if it is performed at a site other than the incision and is medically reasonable and necessary. An incidental hernia repair shall not be reported separately.
4. If a recurrent hernia requires repair, a recurrent hernia repair code may be reported. A code for incisional hernia repair shall not be reported in addition to the recurrent hernia repair code unless a medically necessary incisional hernia repair is performed at a different site. In the latter case, modifier 59 or XS should be used.
5. Removal of excessive skin and subcutaneous tissue (panniculectomy) at the site of an abdominal incision for an open procedure including hernia repair is not separately reportable. CPT code 15830 shall not be reported for this type of panniculectomy. However, an abdominoplasty which requires significantly more work than a panniculectomy is separately reportable.
6. Open enterolysis (CPT code 44005) and laparoscopic enterolysis (CPT code 44180) are defined by the “CPT Manual” as “separate procedures.” They are not separately reportable with other intra-abdominal or pelvic procedures.
7. Extensive and time-consuming enterolysis in conjunction with another intra- abdominal or pelvic procedure. Best to append modifier 22 to the CPT code describing the latter procedure
8. If an iatrogenic laceration/perforation of the small or large intestine occurs during the course of another procedure, repair of the laceration/perforation is not separately reportable. Treatment of an iatrogenic complication of surgery such as an intestinal laceration/perforation is not a separately reportable service. For example, CPT codes describing suture of the small intestine (CPT codes 44602, 44603) or suture of large intestine (CPT codes 44604, 44605) shall not be reported for repair of an intestinal laceration/perforation during an enterectomy, colectomy, gastrectomy, pancreatectomy, hysterectomy, or oophorectomy procedure.
9. A Whipple-type pancreatectomy procedure (CPT codes 48150-48154) includes removal of the gallbladder. A cholecystectomy (e.g., CPT codes 47562-47564, 47600-47620) shall not be reported separately
10. Pelvic exenteration procedures (CPT codes 45126, 51597, 58240) include extensive removal of structures from the pelvis. Providers/suppliers shall not separately report codes for the removal of pelvic structures (e.g., colon, rectum, urinary bladder, uterine body and/or cervix, fallopian tubes, ovaries, lymph nodes, prostate gland)
11. Liver allotransplantation (e.g., CPT code 47135) requires arterial anastomosis of the hepatic artery and anastomosis of the extrahepatic biliary ducts. Providers/suppliers shall not separately report other CPT codes describing these types of services (e.g., 47760, 47780, 47800).
12.  Liver allotransplantation procedures include, if performed, biliary tract T-tube insertion/conversion/exchange/ removal, drainage, or stent procedures (e.g., CPT codes 47533- 47540). CPT codes such as 47531-47541 or 47801 should not be reported with a liver allotransplantation procedure.