1. Laparoscopic/Minimally Invasive Surgery CPT Codes

2. There is a change in the coding process and an addition of a new variable for operations involving minimally invasive approaches for which there are no defined CPT codes such as
Laparoscopy
Thoracoscopy
Endoscopy
Robotic
Hybrid
ETC.

3. Rationale:
This change is being made because coding of procedures using minimally invasive techniques is variable. Specifically, unlisted laparoscopic, thoracoscopic, endoscopic, robotic, hybrid, etc. codes (hereafter referred to as “Minimally Invasive Surgery Codes” or “MIS Codes”) do not allow for comparison with equivalent procedures performed using an open approach.

4. New process: CPT Code Variable:
For all operations that involve minimally invasive approaches for which there are no specific MIS CPT codes,
Determine what procedure was performed from the operative note
Enter the equivalent open CPT code into the “Enter Code” field
If the CPT code is specific for the minimally invasive approach, leave the code as is.

5. New Process
Determine what procedure was performed from the operative note

6. New Process
Enter the equivalent open CPT code into the “Enter Code” field.
There is a sheet provided with all of relevant “nonspecific” codes and their relevant corresponding codes of interest. .

7. New Process
If the CPT code is specific for the minimally invasive approach
Leave the code as is.

8. EXAMPLES

9. Laparoscopic Pyloromyotomy
Laparoscopic pyloromyotomy, coded as “Unlisted laparoscopic procedure, stomach” CPT code 43659
Enter the open CPT code: “Pyloromyotomy, cutting of pyloric muscle (Freder-Ramstedt type operation)”.

10. Laparoscopic Cholecystectomy
Laparoscopic cholecystectomy, coded as “Laparoscopy, surgical; cholecystectomy”,
CPT code 47562
Enter laparoscopic-specific code:

11. NEXT……. “Laparoscopic/MIS Code” Record the Original CPT code: [XXXXX].
Under the New text field in the workstation,
“Laparoscopic/MIS Code”
Record the Original CPT code: [XXXXX].

12. Laparoscopic/MIS Code
For the example of the “Pyloromyotomy, cutting of pyloric muscle /Freder-Ramstedt type operation.” (CPT code: ), that was originally coded as “Unlisted laparoscopic procedure, stomach”
(CPT code 43659)
43659; Would be recorded in this New field,
of “Laparoscopic/MIS Code”

13. Laparoscopic/MIS Variable
For all operations, choose the approach used to perform the operation from the drop-down menu:
Laparoscopic/MIS Only
Laparoscopic/MIS and Open
Open Only or N/A

14. Laparoscopic/MIS Only
Procedure was performed with a laparoscopic or other MIS approach alone
Include procedures that were changed to an open CPT code (using the coding change described previously), and were performed entirely with a laparoscopic/or other MIS approach

15. Laparoscopic/MIS and Open
All procedures that were performed using both Laparoscopic/MIS AND open approaches together.
Laparoscopic/MIS-assisted procedures
Laparoscopic/MIS procedures converted to open, regardless of reason

16. Open Only or N/A
All procedures performed entirely using an open approach
All procedures for which MIS techniques are not applicable (e.g. extremity tumor resection)

17. Additional Guidance
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.
If a diagnostic laparoscopy was performed as part of an open procedure that is not on the CPT code inclusion list (e.g. laparoscopic inguinal exploration for hernia), then do not collect this case.

18. Case Selection:
The next case up for review is a laparoscopic plyoroplasty with a CPT code
This is Not a code included in Appendix B but the surgical procedure is included when listed with an open procedure code of
To allow for comparison with equivalent procedures performed using a MIS approach, we will use the following method.

19. Patients over the age of 18 Trauma cases
Apply the inclusion/exclusion criteria from Chapter 2 to determine if the case should be excluded.
 “Unlisted” CPT codes will need to be included in the CPT inclusion list (which will be provided for you)
EXCLUDE:
Patients over the age of 18
Trauma cases
Case limited CPT codes in appendix D (over 5)
Patient abstracted case in NSQIP within last 30 days
Return to the Operating Room as the principal operative procedure, if it is related to a complication or occurrence from another procedure within 30days or within the same admission

20. Procedure Name
Open CPT code
Description
MIS CPT code
Gastrotomy; foreign body removal
43500
GASTROTOMY; WITH EXPLORATION OR FOREIGN BODY REMOVAL
43659
UNLISTED LAPAROSCOPY PROCEDURE, STOMACH
Pyloromyotomy
43520
PYLOROMYOTOMY, CUTTING OF PYLORIC MUSCLE (FREDET-RAMSTEDT TYPE OPERATION)
Stomach biopsy
43605
BIOPSY OF STOMACH; BY LAPAROTOMY
Excision - ulcer, benign tumor of stomach
43610
EXCISION, LOCAL; ULCER OR BENIGN TUMOR OF STOMACH
Excision - malignant tumor of stomach
43611
EXCISION, LOCAL; MALIGNANT TUMOR OF STOMACH
Pyloroplasty
43800
PYLOROPLASTY
Gastrorrhaphy
43840
GASTRORRHAPHY, SUTURE OF PERFORATED DUODENAL OR GASTRIC ULCER, WOUND, OR INJURY
Gastrostomy closure
43870
CLOSURE OF GASTROSTOMY, SURGICAL
Gastrocolic fistula closure
43880
CLOSURE OF GASTROCOLIC FISTULA

21. If CPT code is an unlisted laparoscopic/other MIS procedure, determine what procedure was performed from the operative note.
If the CPT code for the same operation performed as an open procedure is included in the CPT list, change the CPT code from the unlisted MIS code to the corresponding open CPT code.
If there is no CPT code for the procedure performed using an open approach, or the corresponding open procedure is not on the list of NSQIP-Pediatric CPT codes, then do not include patient in NSQIP-Pediatric database. The case is ineligible.

22. This case of the laparoscopic pyloroplasty meets all the inclusion criteria and is next for review using the systematic sampling process.
It has a CPT code of and it has an included open procedure coded as found on the list of included MIS procedures.
In the CPT Code field: Record CPT code 43800
In the Laparoscopic/MIS Code field:
Record CPT code 43659

23. Laparoscopic/MIS variable
If the CPT code is open (or has been changed to the open code), determine if the procedure was performed using a laparoscopic/MIS approach from the operative note.
If the entire procedure was performed using a laparoscopic/MIS approach, select “Laparoscopic/MIS Only”.
If both laparoscopic/MIS and open approaches were used, select “Laparoscopic/MIS and Open”.
If the entire procedure was performed using an open approach, select “Open Only or N/A”.

24. This change will allow for comparison with equivalent procedures preformed using open and MIS approaches.