Q A new doctor in our practice performed a minilaparotomy with ovarian cystectomy. Since none of our other physicians use this approach, I’m not sure how to code. Any pointers?
A It depends on what you mean by minilaparotomy. In some procedures the incision is small, but it is still an abdominal incision. In others, a “Hasson” or “open field” technique is used, with a small incision to direct the trocar into the correct position. In this case, CPT previously directed coders to add modifier –22 to the primary laparoscopic procedure. (These instructions appeared in CPT as a note before the laparoscopic procedures were distributed throughout the CPT book.)
However, if your physician always uses this technique for performing laparoscopy, the payer will ignore the –22 modifier.
Ms. Witt, former program manager in the Department of Coding and Nomenclature at the American College of Obstetricians and Gynecologists, is an independent coding and documentation consultant. Reimbursement Adviser reflects the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.