Coding Laparoscopy
A laparoscopy is a type of surgery that lets a surgeon look inside your body without making a large incision. This procedure is useful in diagnosing and sometimes treating conditions that develop in your belly or pelvic region. To perform a laparoscopy, a surgeon makes a small cut near your belly button that’s about a half-inch long or less. They then insert a long, thin tube with a camera through the cut and into your body. This tube is called a laparoscope. The camera sends images from inside your body to a video monitor. This allows the surgeon to see inside your body.
In our CPT codebook, code 44202 describes a surgical enterectomy, performed laparoscopically, and includes resection of the small intestine with a single resection and anastomosis. Add-on code +44203 reports each additional small intestine resection and anastomosis.
Codes 44204 and 44205 report laparoscopic partial colectomies with anastomosis and removal of the terminal ileum with ileocolostomy. Colectomy, or removal of part of the colon, is one of the most common laparoscopic procedures. It involves locating the affected area with help of the laparoscope, sealing, and cutting the vessels surrounding the diseased portion of the colon. The diseased segment is extracted through a trocar, or in some cases, through an enlarged abdominal incision. The healthy parts of the colon are secured together. Surgical tape or stitches close the incisions following surgery.
Surgical laparoscopic codes (44204–44212) describe laparoscopic colectomy, which is a treatment for colon conditions including diverticulitis, Crohn’s disease, chronic ulcerative colitis, constipation, and sigmoid volvulus.
Add-on code +44213 reports laparoscopic colon resection for middle to low rectal cancer, followed by an end-to-end colorectal anastomosis between the splenic flexure and the rectum, requiring mobilization of the entire splenic flexure.
Q: What CPT code is reported for a peritoneoscopy with laparoscopic partial colectomy and anastomosis?
A: 44204. Rationale: A peritoneoscopy is a separate procedure and is not separately reportable when it is performed with a more extensive procedure. It is incidental to the laparoscopic partial colectomy and anastomosis. Let’s look in our CPT codebook Index for Colectomy/Partial/with Anastomosis/Laparoscopic. This code is selected based on whether additional procedures, such as a coloproctostomy, are performed. There are no additional procedures in this case making 44204 the correct.
Reference: FY2023 CPT Codebook, CPT Assistant, Mosby’s Medical Dictionary
