CPT Code Description
47562 Laparoscopy, surgical; cholecystectomy – Average fee amount – $600 – $750
47563 – Laparoscopy, surgical; cholecystectomy with cholangiography
47564 – Laparoscopy, surgical; cholecystectomy with exploration of common duct – Average fee amount- $1050 – $1200
Billing and Coding Guidelines.
Clinical Documentation and Prior Authorization Required – Tufts healh plan required authorization for below services.
** Cholecystectomy, Laparoscopic
** Cholecystectomy, Laparoscopic, Cholangiogram Intraoperative with Laparoscopic Cholecystectomy
** Cholecystectomy, Open
** Cholecystectomy, Open, Cholangiogram Intraoperative with Open Cholecystectomy
Medicare Contractor Medical Directors (CMDs) propose that CPT codes 47560, 47562, and 47563 are “potentially misvalued because the more extensive code has lower work RVUs than the less extensive codes.”4 The ACS disagrees and believes that the CMDs may have overlooked the fact that 47560 (Laparoscopy, surgical; with guided transhepatic cholangiography, without biopsy) has a 000-day global period. Additionally, the CMDs may have looked at the CY2012 PFS where 47562 (Laparoscopy, surgical; cholecystectomy) and 47563 (Laparoscopy, surgical; cholecystectomy withcholangiography) were incorrectly ranked. For the Cy2013 PFS, these codes are correctly ranked. CPT code 47560 has a 000-day global period and as a result there is a difference in work between it and codes 47562-47563, which both have 090- day global periods. CPT code 47560 describes a diagnostic laparoscopy plus laparoscopic-guidance for percutaneous insertion of a needle or catheter into the liver parenchyma to access the biliary tree for injection of contrast and performance of trans-hepatic cholangiography. CPT code 47562 describes a diagnostic laparoscopy and surgical removal of the gallbladder. CPT code 47563 describes a diagnostic laparoscopy and surgical removal of the gallbladder with the additional work of an intraoperative cholangiography.
The difference between CPT codes 47562 and 47563 is the work of the intraoperative cholangiography. This work is not the same as the total work included in code 47560. In addition, CPT codes 47562 and 47563 describe more complex surgical procedures that have a 090-day global period compared with 47560 which has a 000-day global period.
Additionally, CPT code 47563 was reviewed in October 2010. In addition, CPT code 47562, which had previously been reviewed in 1995 and 2005, was used as a stable reference service when valuing CPT code 47563. At that time the RUC recommended a wRVU of 12.11 for CPT code 47563, however, CMS reduced the value to 11.47. This resulted in a rank order anomaly for 2012
(47562 wRVU = 11.87; 47563 wRVU = 11.47).
In the CY 2013 PFS, CMS identified CPT codes 47562 and 47563 as potentially misvalued based on a public commenter that questioned the rank order. In January 2012, the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) agreed that the physician work had not changed since the October 2010 review and recommended reaffirmation of the RUC’s original recommendation for correctly ranked work RVUs (11.87 for 47562 and 12.11 for 47563). However, for 2013, CMS did not agree with the RUC and instead further reduced the wRVU for 47562 to correct the rank order anomaly that CMS created when it reduced the wRVU for 47563. Although the wRVUs for 47562 and 47563 do not reflect the RUC review of survey data and RUC recommendation, their work RVUs are correctly ranked.
Note: While you may not be the provider responsible for obtaining prior authorization, as a condition of payment you will need to make sure that prior authorization has been obtained.
Tufts Health Plan requires the use of an InterQual SmartSheet to obtain prior authorization for Cholecystectomies.
In order to obtain prior authorization for procedure(s), choose appropriate InterQual SmartSheet(s) listed below. The completed SmartSheet(s) must be sent to the applicable fax number listed above, according to Plan.
• Cholecystectomy, Laparoscopic
• Cholecystectomy, Laparoscopic, Cholangiogram Intraoperative with Laparoscopic
Cholecystectomy
Code as Denominator – Definition
Any member who underwent an appendectomy or cholecystectomy (laparoscopic or other) during the 365 day period ending 30 days prior to the end of the measurement year.
Denominator Codes
Appendectomy or laparoscopic appendectomy CPT code(s): 44950, 44955, 44960, 44970 Cholecystectomy or laparoscopic cholecystectomy
Cholecystectomy or laparoscopic cholecystectomy CPT code(s): 47562, 47563, 47564, 47600, 47605, 47610, 47612, 47620
UHC payment policy
Laparoscopic cholecystectomy is a covered surgical procedure in which a diseased gall bladder is removed through the use of instruments introduced via cannulae, with vision of the operative field maintained by use of a high-resolution television camera-monitor system (video laparoscope).
Guidelines
For inpatient claims, report the diagnosis code for laparoscopic cholecystectomy. For all other claims, report the appropriate CPT code for laparoscopy, surgical; cholecystectomy (any method), and the appropriate CPT code for laparoscopy, surgical: cholecystectomy with cholangiography.
APPLICABLE CODES
The following list(s) of codes is provided for reference purposes only and may not be all inclusive. Listing of a code in this guideline does not imply that the service described by the code is a covered or non-covered health service. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The inclusion of a code does not imply any right to reimbursement or guarantee claim payment. Other Policies and Guidelines may apply.
CPT Code Description
47562 Laparoscopy, surgical; cholecystectomy
47563 Laparoscopy, surgical; cholecystectomy with cholangiography
47564 Laparoscopy, surgical; cholecystectomy with exploration of common duct
Surgical procedures Statistics
The goal of the surgical cross-over exhibits was to identify total volume, spending, price per procedure, and differences in cost across settings of care for procedures that can be performed either in hospital inpatient or hospital outpatient settings. The five major cross-over procedures were identified as the highest-volume procedures billed by surgeons in 2013 where at least 10 percent of the surgeries occurred at an inpatient hospital and at least 10 percent occurred in a hospital outpatient setting. Total spending includes insurer and enrollee payments for the facility portion of the surgical procedure; the physician portion billed on a separate professional claim is not included. Inpatient procedure costs include the hospital payment for the entire stay associated with the surgery. Outpatient procedure costs include the hospital payment for all lines on the outpatient claim for the surgery. The five procedures are laparoscopic cholecystectomy (CPT procedure code 47562 for outpatient surgeries and ICD-9 procedure code 5123 for inpatient surgeries), laparoscopic appendectomy (CPT 44970 and ICD-9 procedure code 4701), arthrodesis (CPT 22845 and 22551; and ICD-9 procedure code 8102), laparoscopic total hysterectomy (CPT 58570, 58571, 58572, and 58573; and ICD-9 procedure code 6841), and laparoscopic vaginal hysterectomy (CPT 58552, 58553, and 58554; and ICD-9 procedure code 6841).
Cholecystectomy
One of the most common abdominal surgical procedures is cholecystectomy. In the Unites States, 90% are performed laparoscopically. Given the success with this operative approach, laparoscopic cholecystectomy is considered the gold standard for the surgical treatment of gallstone disease. In 1999, Lillemoe, et al. reported on a retrospective analysis of 130 consecutive patients that underwent laparoscopic cholecystectomy in an outpatient surgery unit. A total of eight patients were admitted to the hospital following postanesthesia care, six of these eight patients were discharged on the first postoperative day. The authors concluded that laparoscopic cholecystectomy can be performed as true outpatients within hours of completion of the procedure. Less than 10% of patients will fail this protocol and another 5% may require hospitalization after returning to their homes.
Patients undergoing uncomplicated laparoscopic cholecystectomy for symptomatic cholelithiasis may be discharged home on the day of surgery (Tenconi, et al. 2008). Control of postoperative pain, nausea, and vomiting are important to successful same day discharge, and admission rates despite planned same day discharge are reported to be 1-39%; patients older than age 50 may be at increased risk for admission (Kasem, et al. 2006). Readmission rates range from 0-8%; common causes for readmission after same day discharge include pain, intra-abdominal fluid collections, bile leaks, and bile duct stones (Sherigar, et al. 2006). Time to discharge after surgery for patients with acute cholecystitis, bile duct stones, or in patients converted to an open procedure should be determined on an individual basis.
How do I report an open colon resection and colorectal anastomosis with loop ileostomy for fecal diversion?
You should report CPT code 44146 (see Table 1, page 43). Although the CPT descriptor includes the term “colostomy,” the Medicare physician fee schedule work relative value unit(RVU) for this code is based on creation of either a colostomy or an ileostomy. If this same procedure was performed laparoscopically, the correct code to report would be 44208,Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis) with colostomy. It is incorrect to report a code for ileostomy or jejunostomy (44310 or 44187) with a partial colectomy code (for example, 44145 or 44207) for this procedure, as doing so would be unbundling.
What code do I report for a laparoscopic appendectomy for perforated appendicitis?
Two codes differentiate an open appendectomy without rupture (44950) and with rupture (44960). However, only one code applies to laparoscopic appendectomy (44970), and it is used to report a laparoscopic appendectomy for either scenario; with rupture or without rupture.
How do I report removal of a lipoma of the spermatic cord and repair of a reducible inguinal hernia performed at the same time, through the same incision?
For this clinical scenario, report only the hernia repair code 49505 (see Table 4, page 44). A lipoma or preperitoneal fat that is within the hernia sac or part of the hernia repair would not be separately reported. Code 55520, Excision of lesion of spermatic cord (separate procedure),is a “separate procedure.” Coding tip: When a procedure that is designated as a “separate procedure” is carried out independently or considered to be unrelated or distinct from other procedures/services provided at that time, it may be reported by itself, or in addition to other procedures/services by appending modifier 59 to the specific “separate procedure” code to indicate that the procedure is not considered to be a component of another procedure, but is a distinct, independent procedure. This may represent a different session, different procedure or operation, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries
covered ICD-10
Code Description
0FJB4ZZ Inspection of Hepatobiliary Duct, Percutaneous Endoscopic Approach
0FT44ZZ Resection of Gallbladder, Percutaneous Endoscopic Approach
BF10YZZ Fluoroscopy of Bile Ducts using Other Contrast
BF50200 Other Imaging of Bile Ducts using Fluorescing Agent, Indocyanine Green Dye, Intraoperative
BF502Z0 Other Imaging of Bile Ducts using Fluorescing Agent, Intraoperative
BF52200 Other Imaging of Gallbladder using Fluorescing Agent, Indocyanine Green Dye, Intraoperative
BF522Z0 Other Imaging of Gallbladder using Fluorescing Agent, Intraoperative
BF53200 Other Imaging of Gallbladder and Bile Ducts using Fluorescing Agent, Indocyanine Green Dye, Intraoperative
BF532Z0 Other Imaging of Gallbladder and Bile Ducts using Fluorescing Agent, Intraoperativ
