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Accessibility by Surgery Center of Oklahoma | Jun 1, 2013. Statistical analysis was used to . This is reflected in the relative value units assigned to each procedure: 47562, 18.17; 47563 19.59; 47564, 23.59. . Test us for free with a no obligation trial, get the pricing, and then decide if we are a good fit. When modifier -22 is attached to the open cholecystectomy to note additional effort and time, this V code helps explain to the carrier why the additional payment is being claimed. J Gastrointest Surg. Modifiable lifestyle risk factors include obesity, high fat or high-cholesterol diet, and diabetes. Additionally, by carefully reviewing the surgeons procedure notes, coders may uncover additional payment opportunities. A . KarenZupko & Associates, Inc. | 312.642.5616 | information@karenzupko.com. Cholangiography is often (but not always) performed when a gallbladder is removed to help the surgeon better determine the patients anatomy and to check for gallstones in the common bile duct, says Tray Dunaway, MD, FACS, a general surgeon and evaluation and management coding author in Camden, S.C. Verified questions. With a second grasper, the gallbladder infundibulum is retracted laterally to expose and open Calots Triangle (the area bound by the inferior border of the liver, cystic duct, and common hepatic duct). If you continue to use this site we will assume that you are happy with it. 2022 Oct-Dec;12(4):56-63. doi: 10.4103/jwas.jwas_162_22. Then ligate and divide the ileocolic vessels and any other mesentery to the involved bowel. What is the ICD 10 code for laparoscopic cholecystectomy? The deadline to claim CME credit for the March issue is May 31, 2022. Tip 2: Use Modifier -22 for Significant Additional Time conversion of laparoscopic cholecystectomy; Am J . 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, Code Description0FJB4ZZ Inspection of Hepatobiliary Duct, Percutaneous Endoscopic Approach0FT44ZZ Resection of Gallbladder, Percutaneous Endoscopic ApproachBF10YZZ Fluoroscopy of Bile Ducts using Other ContrastBF50200 Other Imaging of Bile Ducts using Fluorescing Agent, Indocyanine Green Dye, IntraoperativeBF502Z0 Other Imaging of Bile Ducts using Fluorescing Agent, IntraoperativeBF52200 Other Imaging of Gallbladder using Fluorescing Agent, Indocyanine Green Dye, IntraoperativeBF522Z0 Other Imaging of Gallbladder using Fluorescing Agent, IntraoperativeBF53200 Other Imaging of Gallbladder and Bile Ducts using Fluorescing Agent, Indocyanine Green Dye, IntraoperativeBF532Z0 Other Imaging of Gallbladder and Bile Ducts using Fluorescing Agent, Intraoperativ. Sometimes, a laparoscopic cholecystectomy will be converted to an open cholecystectomy for technical reasons or safety. Because a hole was inadvertently left in the bowel, the procedure becomes more complicated and takes longer to complete. 47564 with exploration of common duct. A final point: When a procedure begins by laparoscopic approach, but is completed by open approach, you should report an additional diagnosis of V64.41 Laparoscopic surgical procedure converted to open procedure to describe this circumstance. Between May 2008 and April 2010, 3371 laparoscopic cholecystectomies were performed at Greenville Hospital System University Medical Center. Percutaneous endoscopic approach The fifth of the ICD-10-PCS code is for the approach which identifies the method used to reach the operative site. A few small cuts are required for this procedure. In one cross-sectional study, the conversion from laparoscopic to open surgery for cholecystectomy was only 0.6% (Yuda Handaya et al., 2021). 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? 3 What is the root operation for laparoscopic cholecystectomy? 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. The minor incision does not allow exposure of the abdominal cavity for the laparoscopic diagnostic examination, mobilization of the intestine, vascular ligation, and final irrigation and inspection. Code 74300 (cholangiography and/or pancreatography; intraoperative, radiological supervision and interpretation) can be billed with modifier -26 (professional component) appended. A. January 1, 2014 B. January 1, 2015 C. October 1, 2016 D. October 1, 2015, What is the total number of characters in an ICD-10-PCS code? Medical Billing Question and Answer Terms, EVALUATION AND MANAGEMENT CPT code [99201-99499] Full List, Internal Medical Billing Audit how to do, CPT CODE 47562, 47563, 47564 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY. An additional port may be necessary depending on patient anatomy. 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. As long as you continue on and successfully complete the service, you bill that service only. ICD-10-PCS Description 5123 LAPAROSCOPIC CHOLE 0FT44ZZ Resection of Gallbladder, Percutaneous Endoscopic Approach Discharges, among cases meeting the inclusion and exclusion rules for the denominator, with any-listed ICD-9-CM or ICD-10-PCS procedure codes for laparoscopic cholecystectomy. All our content are education purpose only. 47563 with cholangiography; and Ghazal AH, Sorour MA, El-Riwini M, El-Bahrawy H. Int J Surg. 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. It is a common treatment of symptomatic gallstones and other gallbladder conditions. When you buy a model home do you get the furniture? The cystic duct and the cystic artery are identified, clipped with tiny titanium clips and cut. Laparoscope helps to view inside imaging on screen and removal of gall bladder. Technical modifications to decrease injury rates have been suggested. Procedure: Laparoscopic cholecystectomy Procedure: Small-incision open cholecystectomy: Phase 2 Phase 3: Detailed Description: . Answer: You will code an outpatient consultation with a 57 modifier for the evaluation and management (E & M) service. Radiology tests provide valuable information regarding the location of gallstones, as well as size and effect on organ function. The ACS also provides clarification on coding in such circumstances in its June 1, 2018 bulletin. We use cookies to ensure that we give you the best experience on our website. This column provides information that should clear up the uncertainty about how to correctly code laparoscopic colectomy procedures. Note: If the surgeon must repair a bowel injured by another physician, the procedure should be billed 44602 (suture of small intestine [enterorrhaphy] for perforated ulcer, diverticulum, wound, injury or rupture; single perforation), 44603 (. Converting to gain better access or to facilitate removal of the gallbladder is commonplace and, therefore, modifier -22 shouldnt be used. Nor is appending modifier -22 to the open procedure appropriate in the above scenario, Elliott warns. If the time spent lysing the adhesions is significant (i.e., 25 percent or more of the total time of the operative session), the appropriate lap chole code should be billed with modifier -22 attached. 633 N. Saint Clair St. Common uncontrolable risk factors for gallstone disorders include being female, being 60 years or older, being of Native American or Mexican-American descent, and family history. Treatment for acute cholecystitis is removal of the gallbladder or cholecystectomy. Intraoperative complexity and risk factors associated with conversion to open surgery during laparoscopic cholecystectomy in eight hospitals in Mexico City. If you feel some of our contents are misused please mail us at medicalbilling4u at gmail dot com. The surgeon initially works on the fundus of the gallbladder lysing adhesions and delineating anatomy and the approach appears to be correct. As a result, the surgeon converts to an open procedure. In the years since laparoscopic cholecystectomy was introduced, there has been a noted improvement in the quality of laparoscopic equipment affording a near wholesale shift toward the laparoscopic approach in the surgical management of this condition. Although laparoscopic cholecystectomy is nowadays one of the most performed surgical operation in abdominal surgery, some aspects, concerning the emergency setting, have to be yet investigated. Then mobilize the terminal ileum and ascending colon by incising the lateral peritoneal attachments. So if a laparoscopic biopsy of the liver is performed at the same time as another laparoscopic procedure, unlisted code 47379 should be reported, as there is no CPT code for a laparoscopic liver biopsy. Note: Although some carriers may be paying these claims with modifier -53 appended, such billing is nonetheless incorrect. FOIA Epub 2022 Nov 23. Unauthorized use of these marks is strictly prohibited. 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. Again, modifier -22 should be appended to indicate that significant additional work and time were required to perform the procedure. Going beyond just getting the job done, we can help create sustainable improvement as part of your medical billing team. The design of the study allows wide inclusion criteria for participants . Besides, BDI can also generate significant legal issues in healthcare. When this occurs, HCFA coding guidelines clearly state that only the open procedure should be billed. In some cases, however, surgeons can bill for significant extra work and time by appending modifier -22 to the appropriate procedure code. If a procedure is discontinued before any other root operation is performed, 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. follow-up examination for medical surveillance after treatment (. Two key points have been established. An example of this situation is a failed laparoscopic cholecystectomy, followed by an open cholecystectomy at the same session. Surgeons should be aware that an unlisted procedure requires documentation that provides relevant information, including a proper definition/description of the nature, extent, and need for the procedure, and the time, effort, and equipment necessary to provide the service. government site. This is because open surgery leaves the patient more prone to infection. For example, the surgeon may: 2021 Jul 30;68:102631. doi: 10.1016/j.amsu.2021.102631. Only the CPT code for one of the services, generally the more invasive service, should be reported. Accomplish the anastomosis between the ileum and the remaining ascending colon by stapling with a gastrointestinal anastomosis stapler to join the two limbs of bowel. 11,17,24 These technical recommendations and proctoring of surgeons during their first LCs . official website and that any information you provide is encrypted Surg Endosc. Conversion to open cholecystectomy . The American College of Surgeons (ACS), the American Society of Colon and Rectal Surgeons (ASCRS), and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) have recently received inquiries about correct Current Procedural Terminology (CPT*) coding for colectomy procedures. Some surgeons routinely include cholangiography (many surgeons have been trained to do so), whereas others may perform the service only for specific indications, such as an elevated liver function study, an ultrasound that shows an enlarged common bile duct or because the patient has a history of gallstone pancreatitis. Safe laparoscopic subtotal cholecystectomy in the face of severe inflammation in the cystohepatic triangle: a retrospective review and proposed management strategy for the difficult gallbladder. Close the defect in the mesentery using an absorbable running stitch, and then place the bowel back within the abdominal cavity. 8600 Rockville Pike We will take care of your Medical Billing and Coding, Dental Billing, Insurance Verification and Prior Authorization requirements efficiently. Additionally, CPT code 47563 was reviewed in October 2010. This is the American ICD-10-CM version of Z53.31 - other international versions of ICD-10 Z53.31 may differ. Answer: CPT 81479 oninvasive Prenatal Testing for Fetal Aneuploidies, Top 13 denials in RCM and how to prevent the denials, Critical care codes Usage , Time, Documentation, Medical necessity condition with example, CPT Code 99201, 99202, 99203, 99204, 99205 Which code to USE. The CPT codes for cholecystectomy (outpatient) effective January 1, 2018 are as follows: Awareness of issues such as severity, laterality, specific location, chronicity, causation, and treatment encounter is crucial to ensure specificity in ICD-10 coding. If you read the top of the operative report, it may list laparoscopic cholecystectomy only, but the procedure notes in the operative report clearly state that a cholangiogram was performed, Elliott says. Today, gallbladder removal is done laparoscopically without requiring a large abdominal incision. One of the most common abdominal surgical procedures is cholecystectomy. Additional ports are opened inferior to the ribs at the epigastric, midclavicular, and anterior axillary positions. In certain circumstances, the procedure must be converted to open to safely complete the operation. Answered 1 year ago. This type of surgery requires meticulous surgical skill, but in straightforward cases, it can be done in about an hour. However, inflammation, adhesions, and anatomic difficulty continue to challenge the use and safety of this approach in a small number of patients. Verified answer. Surgical options include the standard procedure, called laparoscopic cholecystectomy, and an older more invasive procedure, called open cholecystectomy. perform extensive lysis of adhesions; Clinical Documentation and Prior Authorization Required Tufts healh plan required authorization for below services. He documented both approaches and the laparoscopic approach took significant time before he had to convert to open. Laparoscopic cholecystectomy icd 10 procedure code. Free market-loving, price-displaying, state-of-the-art, AAAHC accredited, doctor owned, multispecialty surgical facility in central OK.Liquid Media. It appears that national coder websites and coder discussion boards have been providing incorrect coding guidance, which may represent the root cause of the coding confusion. 2020 Oct 18;17(20):7571. doi: 10.3390/ijerph17207571. If there is a low risk of complications, the surgery is usually done as an outpatient procedure. Insurance Denial Claim Appeal Guidelines. Only the code for the successful procedure, in this case the open cholecystectomy, should be reported. For this clinical scenario, report only the hernia repair code 49505 (see Table 4, page 44). This site needs JavaScript to work properly. A. Ann Med Surg (Lond). Read More. Physicians receive up to 6.5 AMA PRA Category 1 Credits for each day of participation. My doctor started a laparoscopic cholecystectomy that had . Solution. For example, cholangiograms are frequently performed in conjunction with cholecystectomies (both laparoscopic and open), but occasionally the former procedure is not listed at the top of the operative report. 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. Surgical options include the standard procedure, called laparoscopic cholecystectomy, and an older more invasive procedure, called open cholecystectomy. A lap chole involves removal of the gallbladder using a laparoscope, and may be performed with or without cholangiography. Only the completed surgical procedure may be reported. Example: Laparoscopic cholecystectomy converted to an open cholecystectomy is coded as percutaneous endoscopic Inspection and open Resection. 2002 Nov-Dec;6(6):800-5. doi: 10.1016/s1091-255x(02)00064-1. The second procedure is usually performed because the initial approach was unsuccessful in accomplishing the medically necessary service; those procedures are considered sequential procedures. Study with Quizlet and memorize flashcards containing terms like What is the implementation date of ICD-10-PCS? As the surgeon moves deeper (toward the cystic duct and artery), however, the patients anatomy becomes indiscernible due to a solid mass of inflammation. After an extracorporeal anastomosis, the colon is returned to the abdomen, the extraction site is closed, pneumoperitoneum is reestablished, and the remainder of the procedure is performed laparoscopically, including final irrigation and inspection. Clinical example: A 27-year-old male patient has had Crohns disease (CD) of the terminal ileum for six years. 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. Because of overutilization, modifier -22 has become a red flag for audit, and physicians must abide by stringent documentation and compliance guidelines when using it. procedure converted to open procedure, to show the conversion to open procedure. Just because a procedure was converted from laparoscopic to open does not automatically justify the use of modifier -22, she explains. 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. help the operating surgeon code the surgery as simple or difficult. The small intestine has three parts. calculus. (2021). Please reach out and we would do the investigation and remove the article. What is the CPT code for cholecystectomy? 2017, and November 30, 2021. 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). Description of procedure: Place trocars through the abdominal wall at the umbilicus, right lower quadrant, and lower midline. 1 of 2. Question: I code from the record, never by what doctors write at the beginning. 2019 Dec 1;62(6):402-411. doi: 10.1503/cjs.014617. An initial approach to a procedure may be followed at the same encounter by a second, usually more invasive approach. Let's ra, With the large amounts of clinical documentation a, Arterial embolization is a minimally-invasive proc, Need professional support to meet those medical bi, February is observed as American Heart Month, Streamline the billing process and prevent claim d, Cracking the Code: Understanding CDT Codes for Dental Bridges, Dental Billing Codes for Reporting Osseous Surgery, K80.00 (calculus of gallbladder with acute cholecystitis without obstruction, K80.01 (calculus of gallbladder with acute cholecystitis with obstruction, K80.10 (calculus of gallbladder with chronic cholecystitis without obstruction), K80.11 (calculus of gallbladder with chronic cholecystitis with obstruction), K80.12 (calculus of gallbladder with acute and chronic cholecystitis without obstruction), K80.13 (calculus of gallbladder with acute and chronic cholecystitis with obstruction), K80.18 (calculus of gallbladder with other cholecystitis without obstruction), K80.19 (calculus of gallbladder with other cholecystitis with obstruction), K80.20 (calculus of gallbladder without cholecystitis without obstruction), K80.21 (calculus of gallbladder without cholecystitis with obstruction), K80.30 (calculus of bile duct with cholangitis, unspecified, without obstruction, K80.31 (calculus of bile duct with cholangitis, unspecified, with obstruction), K80.32 (calculus of bile duct with cholangitis, without obstruction), K80.33 (calculus of bile duct with cholangitis, with obstruction), K80.34 (calculus of bile duct with chronic cholangitis, without obstruction), K80.35 (calculus of bile duct with chronic cholangitis, with obstruction), K80.36 (calculus of bile duct with acute and chronic cholangitis, without obstruction), K80.37 (calculus of bile duct with acute and chronic cholangitis, with obstruction), K80.40 (calculus of bile duct with cholecystitis, unspsecified without obstruction), K80.41 (calculus of bile duct with cholecystitis, unspecified, with obstruction), K80.42 (calculus of bile duct with acute cholecystitis without obstruction), K80.43 (calculus of bile duct with acute cholecystitis with obstruction), K80.44 (calculus of bile duct with chronic cholecystitis without obstruction), K80.45 (calculus of bile duct with chronic cholecystitis with obstruction), K80.46 (calculus of bile duct with acute and chronic cholecystitis without obstruction), K80.47 (calculus of bile duct with acute and chronic cholecystitis with obstruction), K80.50 (calculus of bile duct without cholangitis or cholecystitis without obstruction), K80.51 (calculus of bile duct without cholangitis or cholecystitis with obstruction), K80.60 (calculus of gallbladder and bile duct with cholecystitis, unspecified, without obstruction), K80.61 (calculus of gallbladder and bile duct with cholecystitis, unspecified, with obstruction), K80.62 (calculus of gallbladder and bile duct with acute cholecystitis without obstruction), K80.63 (calculus of gallbladder and bile duct with acute cholecystitis with obstruction), K80.64 (calculus of gallbladder and bile duct with chronic cholecystitis without obstruction), K80.65 (calculus of gallbladder and bile duct with chronic cholecystitis with obstruction), K80.66 (calculus of gallbladder and bile duct with acute and chronic cholecystitis without obstruction), K80.67 (calculus of gallbladder and bile duct with acute and chronic cholecystitis with obstruction), K80.7 (calculus of gallbladder and bile duct without cholecystitis), K80.70 (calculus of gallbladder and bile duct without cholecystitis without obstruction), K80.71 (calculus of gallbladder and bile duct without cholecystitis with obstruction), K80.80 (other cholelithiasis without obstruction), K80.81 other cholelithiasis with obstruction), K81.2 (acute cholecystitis with chronic cholecystitis), 47562 (laparoscopic cholecystectomy without cholangiography), 47563 (laparoscopic cholecystectomy with cholangiography), 47564 (laparoscopic cholecystectomy with exploration of the common bile duct), 47600 (cholecystectomy without cholangiography), 47605 (cholecystectomy with cholangiography), 47610 (cholecystectomy with exploration of the common bile duct), 47612 (cholecystectomy with exploration of common bile duct; with choledochoenterostomy), 47620 (cholecystectomy with exploration of common duct; with transduodenal sphincterotomy or sphincteroplasty, with or without cholangiography). Natalie joined MOS Revenue Cycle Management Division in October 2011. 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. A laparoscopic colectomy is performed with most of the procedure completed intracorporeally, including, but not limited to, a diagnostic laparoscopy, mobilization of the intestine, vascular ligation, and bowel transection. 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. by Natalie Tornese | Last updated Mar 3, 2023 | Published on Jun 29, 2018 | Blog, Medical Coding. American Hospital Association ("AHA"). Gallbladder stones could move into the common bile duct after gallbladder contraction, causing acute cholecystitis. Federal government websites often end in .gov or .mil. Because carriers dictate specific requirements for modifier -22, such claims should include a separate paragraph that describes the additional work involved, notes the additional time spent and explains (briefly, in simple terms) why the additional work was necessary. Resection is the root operation because the entire gallbladder was resected. 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. In addition, gangrenous changes and initial dissection result in perforations and consequent bile spillage. Following trends in national coding blogs and websites, institutional coders have concluded that extracorporeal extraction and creation of an anastomosis is an open procedure, making the operation an open colectomy. Extraction of a specimen and/or creation of anastomosis does not constitute the majority of the procedure. References Atiq-ur-Rehman, S., Hussain, S., Khan, M. Y., & Masood, U. In order to obtain prior authorization for procedure(s), choose appropriate InterQual SmartSheet(s) listed below. Eighty-six patients (2.6%) required conversion to open cholecystectomy during the study period. Colectomy codes are identified as either open or laparoscopic. Coders must also be aware of several coding guidelines and bundling edits that may apply. The laparoscope reveals that the area containing the gallbladder is severely inflamed and purulent. ** Cholecystectomy, Laparoscopic, Cholangiogram Intraoperative with Laparoscopic Cholecystectomy, ** Cholecystectomy, Open, Cholangiogram Intraoperative with Open Cholecystectomy. What is the CPT code for a cholangiogram? For example: According to the national Correct Coding Manual: 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 RUCs original recommendation for correctly ranked work RVUs (11.87 for 47562 and 12.11 for 47563). The willingness and ability of surgeons to convert to open cholecystectomy continues to be important to the safety of this operation. For example, if the surgeon must perform extensive lysis of adhesions, 44200 (laparoscopy, surgical; enterolysis [freeing of intestinal adhesion] [separate procedure]) cannot be billed in addition to 47562 because the codes are bundled in the national Correct Coding Initiative (just as 44005, the code for open lysis of adhesions, is bundled to 47600, the open cholecystectomy code). How to Market Your Business with Webinars? Then the gallbladder is dissected away from the liver bed and removed through one of the ports. 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. The completed SmartSheet(s) must be sent to the applicable fax number listed above, according to Plan. Cholecystectomy, Laparoscopic Cholecystectomy, Laparoscopic, Cholangiogram Intraoperative with LaparoscopicCholecystectomy. . Z53.31 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Biliary tract injuries during laparoscopic cholecystectomy: three case reports and literature review. Different techniques have been described to reduce the incidence of this complication, and near-infrared . All Rights Reserved to AMA. You may appropriately bill the extra time using modifier -22. The CPT codes for cholecystectomy (outpatient) effective January 1, 2018 are as follows: 47562 (laparoscopic cholecystectomy without cholangiography) 47563 (laparoscopic cholecystectomy with cholangiography) 47564 (laparoscopic cholecystectomy with exploration of the common bile duct) 47600 (cholecystectomy without cholangiography) Epub 2009 May 27. Facilities, not physicians, report ICD-10-PCS codes, and these codes define various approaches that do not correspond to CPT coding (open, closed, percutaneous, laparoscopic). +CPT Code 47550 is an Add-On code and must be reported with a primary procedure. 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.