An unlisted laparoscopy code should be assigned when a specific procedure code is

not
available for the applicable anatomic ite.

Examples of some of the digestive system laparo copic procedures are:

43280 Laparoscopy, surgical, esophagogastric fundoplasty (for example, Nissen,

Toupet procedures)

44970 Laparoscopy, surgical, appendectomy

It is important to di tingui h the laparoscopic approach from another approach,

such as laparo
scopic gastrostomy, code 43653, which must be distinguished from gastrostomy
accomplished
by open surgery (43830-43832) or percutaneous approach (43246 or 49440).

Endoscopy

Endoscopy codes specify type of instrument used, purpose of the endoscopy, and site
of appli
cation.

The gastrointestinal (GI) subsection contains several guidelines involving

endoscopies:

• Diagnostic endoscopies are not reported separately when performed in conjunction

with a urgicaJ endoscopy.

• When multiple procedures are performed through the endoscope, separate code are
reported for each procedure, when appropriate. The multiple procedure modifier -5 i

should be used for each sub equent procedure performed through the scope.

When performing a GI endo copy, the physician may encounter one or many lesions.
Biopsies of some or all lesions may be taken. Lesion removal may be performed after

a biopsy or without a biopsy. Therefore, the following guidelines should be

applied:

o When a biopsy of a lesion is taken and the remaining portion of the same lesion
is
excised during the arne operative episode, a code should be assigned for the exci
sion only (CPT Assistant, February 1999).

o When one lesion is biop ied and a different Ie ion is excised, one code should be

assigned for the biopsy and one for the excision. This rule is applicable unless
the
excision code narrative includes the phrase "with or without biopsy." In this ca e,

only the exci ion code is assigned. It would be appropriate to append the biopsy
code
with modifier -59, Distinct Procedural Service. For patients covered by Medicare"
instead of modifier -59, one of four other modifiers must be used to more clear lW
define a distinct procedure. The modifiers are:

-XE: Separate encounter

-XP: Separate practitioner

-XS: Separate structure (or organ)

-XU: Unusual non-overlapping service

o Biopsy codes u e the terminology "with biop y, single or multiple." These codes
are
to be used only once, regard Ie s of the number of biopsies taken.

o Biopsy forceps may be passed through a scope to remove tissue from a suspect
area;
a cytology brush may I .., passed through the cope to obtain cells from the surface

of a lesion; a suction apparatu may be used to remove foreign bodies or mucous