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Tip: Manage laparoscopic cholecystectomy procedure billing

Ambulatory Surgery Reimbursement Update, November 4, 2008

A laparoscopic cholecystectomy procedure involves removal of the gallbladder using laparoscopic instruments.

Note the following:

• Use code 47562 to report a laparoscopic cholecystectomy procedure without cholangiography (i.e., imaging of the gallbladder)
• Use code 47563 for a laparoscopic cholecystectomy with cholangiography
• Use code 47564 for a laparoscopic cholecystectomy with cholangiography procedure, with exploration of the common bile duct

Do not bill codes 47563 and 47564 together. Choose the most appropriate code only.

Physicians may perform certain related procedures (e.g., bowel injury requiring repair, extensive lysis of adhesions, etc.) with laparoscopic cholecystectomy procedures. Coders can bill for these procedures separately (using a modifier -59 if unbundled) when the surgeon documents in the operative report that the procedure required significant additional time and effort in addition to the laparoscopic cholecystectomy procedure.

Conversion of a laparoscopic procedure to an open procedure can occur as a result of inflammation or very extensive adhesions causing complications during the laparoscopic cholecystectomy procedure. When this occurs, bill the code for the most invasive procedure (i.e., bill the open procedure only, not the laparoscopic procedure).

Ensure you perform laparoscopic cholecystectomy procedures on healthy Medicare patients, since Medicare does not allow overnight stays in ASCs. Consider referring unhealthy or frail Medicare patients to the hospital setting for laparoscopic cholecystectomy procedures.

This tip is brought to you by Ellis Medical Consulting, Inc.

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