Laparoscopy procedures without CPT codes in CPT book.

We are experiencing our Physicians doing Laparoscopic Procedures where there is not an existing code. The use of the unlisted is just not as payable as an existing code.

What options would we have in the above scenario? Can we use the open codes?



Please Advise.

Laparoscoping in N.C.

Laparoscopy procedures without CPT codes in CPT book

Unfortunately, you are required to use the unlisted code.

Send a letter briefly explaining the procedure, and tell the payer what existing CPT code it is comparable to. Send a copy of the OP note.

For your commercials, perhaps you can do this and negotiate a fee for the service.

Then, submit a request to the CPT panel telling them about the service and requesting a new CPT code. That's how the surgeons got the hernia lap codes this year. Also, talk to your specialty society, because the specialty societies have representatives on the AMA committees.

Unlisted Lap procedure

For any "unlisted" code the payer will conduct a review to see:
- Whether the procedure or service requested by an unlisted code actually has a specific CPT code that is more appropriate. An unlisted code must be medically necessary. This would include determinations of whether:
- There is a medical problem,
- The procedure is appropriate to address the problem,
- The procedure is of proven efficacy, and/or the standard of care
- Whether the site of service requested is appropriate
The coder should also review the Category III codes before assigning an unlisted code. If a Category III code is available, it must be assigned.

Do not recommend submitting an "open" code because that is not the technique described.