Tuesday, September 13, 2016

CPT CODE 47562, 47563, 47564 - Laparoscopy, surgical; cholecystectomy

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 Guidelines.

Medical Necessity Guidelines: Cholecystectomy-Open and Laparoscopic

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 with
cholangiography) 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.


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).

No comments:

Post a Comment

Most read colonoscopy CPT codes