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.