Medical Billing Dilemma – Reporting Two Codes

When a laparoscopic procedure is performed, it may seem like it should be reported separately from the open procedure, however at this time, most carriers and that includes Medicare will only pay for one open procedure no matter how much work the surgeon does laparoscopically beforehand.

With very rare exception, you should report the open procedure only as using the laparoscopic code may result in your medical billing claimed being deemed over coded and will be rejected. Another rule of thumb to know when reporting this type of procedure is when an endoscopic procedure is attempted and fails on the patient and then another surgical service is rendered, only the successful treatment is reported.

Additionally, make sure that you include any secondary diagnosis of V64.41 (Laparoscopic surgical procedure converted to open procedure) to show that the surgeon started off laparoscopically and then converted to using an open procedure on the patient). Additionally, if you have a rare complication or situation, you can use modifier 22 (Unusual procedural services) to the procedure, but be prepared to back up your medical billing claim with medical necessity or you can expect some resistance from the carrier to reimburse.

View all Articles by: Melissa Clark, CCS-P