2023 CPT coding guidelines for Laparoscopy / Coding guidelines for digestive system CPC exam

2023 CPT coding guidelines for Laparoscopy / Coding guidelines for digestive system

LAPAROSCOPIC SURGERY CPT CODES 49320, 58661

What is Laparoscopy

The physician inserts a fiberoptic laparoscope to observe the necessary organs in these procedures. Laparoscopy can be used to help diagnose a wide range of conditions that develop inside the abdomen or pelvis. It can also be used to carry out surgical procedures, such as removing a damaged or diseased organ, or removing a tissue sample for further testing (biopsy).

1.  Surgical laparoscopy includes diagnostic laparoscopy, which is not separately reportable. If a diagnostic laparoscopy leads to a surgical laparoscopy at the same patient encounter, only the surgical laparoscopy may be reported. 

2.  If a laparoscopy is performed  or extent of disease, it is not separately reportable. If the findings of a diagnostic laparoscopy lead to the decision to perform an open procedure, the diagnostic laparoscopy may be separately reportable. Modifier 58 may be reported to indicate that the diagnostic laparoscopy and non-laparoscopic therapeutic procedures were staged or planned procedures. The medical record must indicate the medical necessity for the diagnostic laparoscopy.

3. CPT code 49321 describes a laparoscopic biopsy. If this procedure is performed for diagnostic purposes and the decision to proceed with an open or laparoscopic –ectomy procedure is based on this biopsy, CPT code 49321 may be reported in addition to the CPT code for the –ectomy procedure. However, if the laparoscopic biopsy is performed for a different purpose such as assessing the margins of resection, CPT code 49321 is not separately reportable.

What is the guidelines for Laparoscopic converted to an Open method

    If a laparoscopic procedure is converted to an open procedure, only the open procedure may be reported. Neither a surgical laparoscopy nor a diagnostic laparoscopy code shall be reported with the open procedure code when a laparoscopic procedure is converted to an open procedure. 

What is the guidelines for Diagnostics VS Therapeutic procedure 

If the main objective is to establish a diagnosis for the patient prior to starting any kind of treatment, then it is considered to be a diagnostic procedure. If a diagnosis is already established and a procedure is completed in order to eradicate a problem, then it is considered to be a therapeutic procedure.

Inclusive Procedure

5. Laparoscopic lysis of adhesions (CPT codes 44180 or 58660) is not separately reportable with other surgical laparoscopic procedures.

6. CPT code 44970 describes a laparoscopic appendectomy and may be reported separately with another laparoscopic procedure code when a diseased appendix is removed. Since removal of a normal appendix with another laparoscopic procedure is not separately reportable, this code shall not be reported for an incidental laparoscopic appendectomy

7. Fluoroscopy (CPT code 76000) is an integral component of all laparoscopic procedures, when performed. CPT code 76000 shall not be reported separately with a laparoscopic procedure.

8. A diagnostic laparoscopy includes “washing,” infusion, and/or removal of fluid from the body cavity. A provider/supplier shall not report CPT codes 49082-49083 (Abdominal paracentesis) or 49084 (Peritoneal lavage) for infusion and/or removal of fluid  from the body cavity performed during a diagnostic or surgical laparoscopic procedure. 

9.  Injection of air into the abdominal or pelvic cavity is integral to many laparoscopic procedures. Providers/suppliers shall not separately report CPT code 49400 (Injection of air or contrast into peritoneal cavity (Separate procedure)) for this service.

10  CPT codes 43281 and 43282 describe laparoscopic paraesophageal hernia repair with fundoplasty, if performed, without or with mesh implantation respectively. These codes shall not be reported for a figure-of-eight suture often performed during gastric restrictive procedures.