Laparotomy vs. Open procedure

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Joined: Sat Dec 20, 2014 9:32 pm

Thu Sep 26, 2019 12:28 pm

Hello! Thank you in advance for any guidance you can give us on this subject. We see these type of notes frequently, and want to be sure we are coding correctly.

[/From a recent chart note:b]

"The 2 specimen retrieval bags were grasped trough the camera port. The pneumoperitoneum was evacuated and trocars were removed. A small laparotomy was then performed at the site of the camera port extending the incision for about 1 inch. The fascia was divided and the specimens were then retrieved and sent for frozen section."

Question: Should this process be considered a laparoscopic procedure, or a procedure that has been converted to open?

Our outside auditing company doesn't really have clear guidance on this and it seems as thought from our internal prior group discussions, each coder views this type of case slightly differently.

Two of us see laparoscopic surgeries with (as the provider calls them) "mini/small laparotomies" for specimen removal frequently and have never coded as an "open" procedure or added modifier 22 based on the rationale that there is no significant extra work demonstrated in the documentation, and also because the procedure was completed via the laparoscopic instruments - all detachments were made laparoscopic and the surgery completed - they just have to enlarge an opening to remove a large specimen. This does not seem like they are doing the entire procedure open, or even starting it lap and due to adhesions or other complications converting to an open procedure for better visualization in order to complete the surgery.

Years ago, they used to morcellate the specimen to fit it out a lap port, but they found this was unsafe as there could be unsuspecting cancer cells in the specimen that might be spread intra-abdominally, so it was advised against doing it this way. The better, safer alternative is to remove the specimen whole via an enlarged incision.

Other coders in our group are in agreement that "mini-laparotomies" (again, the provider's phrasing) and hand assisted laparotomies are considered laparoscopic and are coded as such, however, if the procedure is converted to open at any point during the procedure, they have been directed to code as an "open" procedure based on understanding and experience with outside auditors in different employments.

What is NAMA's direction for this?

Thank you,

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