Laparoscopic/Minimally Invasive Surgery CPT Codes - PowerPoint PPT Presentation

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Laparoscopic/Minimally Invasive Surgery CPT Codes

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... or injury 43659 unlisted laparoscopy procedure, stomach gastrostomy closure 43870 closure of gastrostomy, surgical 43659 unlisted laparoscopy procedure, ... – PowerPoint PPT presentation

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Title: Laparoscopic/Minimally Invasive Surgery CPT Codes


1
Laparoscopic/Minimally Invasive SurgeryCPT
Codes
2
  • There is a change in the coding process and an
    addition of a new variable for operations
    involving minimally invasive approaches for which
    there are no defined CPT codes such as
  • Laparoscopy
  • Thoracoscopy
  • Endoscopy
  • Robotic
  • Hybrid
  • ETC.

3
  • Rationale
  • This change is being made because coding of
    procedures using minimally invasive techniques is
    variable. Specifically, unlisted laparoscopic,
    thoracoscopic, endoscopic, robotic, hybrid, etc.
    codes (hereafter referred to as Minimally
    Invasive Surgery Codes or MIS Codes) do not
    allow for comparison with equivalent procedures
    performed using an open approach.

4
New process
  • CPT Code Variable
  • For all operations that involve minimally
    invasive approaches for which there are no
    specific MIS CPT codes,
  • Determine what procedure was performed from the
    operative note
  • Enter the equivalent open CPT code into the
    Enter Code field
  • If the CPT code is specific for the minimally
    invasive approach, leave the code as is.

5
New Process
  • Determine what procedure was performed from the
    operative note

6
New Process
  • Enter the equivalent open CPT code into the
    Enter Code field.
  • There is a sheet provided with all of relevant
    nonspecific codes and their relevant
    corresponding codes of interest.

.
7
New Process
  • If the CPT code is specific for the minimally
    invasive approach
  • Leave the code as is.

8
EXAMPLES
9
Laparoscopic Pyloromyotomy
  • Laparoscopic pyloromyotomy, coded as Unlisted
    laparoscopic procedure, stomach CPT code 43659
  • Enter the open CPT code 43520 Pyloromyotomy,
    cutting of pyloric muscle (Freder-Ramstedt type
    operation).

10
Laparoscopic Cholecystectomy
  • Laparoscopic cholecystectomy, coded as
    Laparoscopy, surgical cholecystectomy,
  • CPT code 47562
  • Enter laparoscopic-specific code 47562.

11
NEXT.
  • Under the New text field in the workstation,
  • Laparoscopic/MIS Code
  • Record the Original CPT code XXXXX.

12
Laparoscopic/MIS Code
  • For the example of the Pyloromyotomy, cutting of
    pyloric muscle /Freder-Ramstedt type operation.
    (CPT code 43520), that was originally coded as
    Unlisted laparoscopic procedure, stomach
  • (CPT code 43659)
  • 43659 Would be recorded in this New field,
  • of Laparoscopic/MIS Code

13
Laparoscopic/MIS Variable
  • For all operations, choose the approach used to
    perform the operation from the drop-down menu
  • Laparoscopic/MIS Only
  • Laparoscopic/MIS and Open
  • Open Only or N/A

14
Laparoscopic/MIS Only
  • Procedure was performed with a laparoscopic or
    other MIS approach alone
  • Include procedures that were changed to an open
    CPT code (using the coding change described
    previously), and were performed entirely with a
    laparoscopic/or other MIS approach

15
Laparoscopic/MIS and Open
  • All procedures that were performed using both
    Laparoscopic/MIS AND open approaches together.
  • Laparoscopic/MIS-assisted procedures
  • Laparoscopic/MIS procedures converted to open,
    regardless of reason

16
Open Only or N/A
  • All procedures performed entirely using an open
    approach
  • All procedures for which MIS techniques are not
    applicable (e.g. extremity tumor resection)

17
Additional Guidance
  • A diagnostic laparoscopy (CPT 49320) or
    laparotomy (CPT 49000) should be entered as the
    principal operative procedure only when no other
    procedure eligible for assessment has been
    performed in that particular surgical case.
  • If a diagnostic laparoscopy was performed as part
    of an open procedure that is not on the CPT code
    inclusion list (e.g. laparoscopic inguinal
    exploration for hernia), then do not collect this
    case.

18
  • Case Selection
  • The next case up for review is a laparoscopic
    plyoroplasty with a CPT code 43659.
  • This is Not a code included in Appendix B but the
    surgical procedure is included when listed with
    an open procedure code of 43800.
  • To allow for comparison with equivalent
    procedures performed using a MIS approach, we
    will use the following method.

19
  • Apply the inclusion/exclusion criteria from
    Chapter 2 to determine if the case should be
    excluded.
  •  Unlisted CPT codes will need to be included in
    the CPT inclusion list (which will be provided
    for you)
  • EXCLUDE
  • Patients over the age of 18
  • Trauma cases
  • Case limited CPT codes in appendix D (over 5)
  • Patient abstracted case in NSQIP within last 30
    days

20
Procedure Name Open CPT code Description MIS CPT code Description
Gastrotomy foreign body removal 43500 GASTROTOMY WITH EXPLORATION OR FOREIGN BODY REMOVAL 43659 UNLISTED LAPAROSCOPY PROCEDURE, STOMACH
Pyloromyotomy 43520 PYLOROMYOTOMY, CUTTING OF PYLORIC MUSCLE (FREDET-RAMSTEDT TYPE OPERATION) 43659 UNLISTED LAPAROSCOPY PROCEDURE, STOMACH
Stomach biopsy 43605 BIOPSY OF STOMACH BY LAPAROTOMY 43659 UNLISTED LAPAROSCOPY PROCEDURE, STOMACH
Excision - ulcer, benign tumor of stomach 43610 EXCISION, LOCAL ULCER OR BENIGN TUMOR OF STOMACH 43659 UNLISTED LAPAROSCOPY PROCEDURE, STOMACH
Excision - malignant tumor of stomach 43611 EXCISION, LOCAL MALIGNANT TUMOR OF STOMACH 43659 UNLISTED LAPAROSCOPY PROCEDURE, STOMACH
Pyloroplasty 43800 PYLOROPLASTY 43659 UNLISTED LAPAROSCOPY PROCEDURE, STOMACH
Gastrorrhaphy 43840 GASTRORRHAPHY, SUTURE OF PERFORATED DUODENAL OR GASTRIC ULCER, WOUND, OR INJURY 43659 UNLISTED LAPAROSCOPY PROCEDURE, STOMACH
Gastrostomy closure 43870 CLOSURE OF GASTROSTOMY, SURGICAL 43659 UNLISTED LAPAROSCOPY PROCEDURE, STOMACH
Gastrocolic fistula closure 43880 CLOSURE OF GASTROCOLIC FISTULA 43659 UNLISTED LAPAROSCOPY PROCEDURE, STOMACH
21
  • If CPT code is an unlisted laparoscopic/other MIS
    procedure, determine what procedure was performed
    from the operative note.
  •  
  • If the CPT code for the same operation performed
    as an open procedure is included in the CPT list,
    change the CPT code from the unlisted MIS code to
    the corresponding open CPT code.
  •  
  • If there is no CPT code for the procedure
    performed using an open approach, or the
    corresponding open procedure is not on the list
    of NSQIP-Pediatric CPT codes, then do not include
    patient in NSQIP-Pediatric database. The case is
    ineligible.

22
  • This case of the laparoscopic pyloroplasty meets
    all the inclusion criteria and is next for review
    using the systematic sampling process.
  • It has a CPT code of 43659 and it has an included
    open procedure coded as 43800 found on the list
    of included MIS procedures.
  • In the CPT Code field Record CPT code 43800
  • In the Laparoscopic/MIS Code field
  • Record CPT code 43659

23
Laparoscopic/MIS variable
  • If the CPT code is open (or has been changed to
    the open code), determine if the procedure was
    performed using a laparoscopic/MIS approach from
    the operative note.
  •  
  • If the entire procedure was performed using a
    laparoscopic/MIS approach, select
    Laparoscopic/MIS Only.
  •  
  • If both laparoscopic/MIS and open approaches were
    used, select Laparoscopic/MIS and Open.
  •  
  • If the entire procedure was performed using an
    open approach, select Open Only or N/A.
  •  

24
  • This change will allow for comparison with
    equivalent procedures preformed using open and
    MIS approaches.
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