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MP 10.01.08

Laparoscopic, Endoscopic, Thoracoscopic Surgery

 

 

Medical Policy    
Section
Administrative
Original Policy Date
4/1/98
Last Review Status/Date
Reviewed by consensus/4:2002
Issue
4:2002
  Return to Medical Policy Index

Disclaimer

Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract.  Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage.  Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.

 


 

Description

As used in this policy, endoscopic surgery is a general term describing a form of minimally invasive surgery in which access to a body cavity is achieved through several small percutaneous incisions. The surgery is performed using specialized instrumentation inserted through the incisions (i.e., trocar sites) and guided by the use of a fiberoptic endoscope that provides visualization of the body cavity on a video screen. In endoscopic surgery, the surgeon does not have direct visualization of the surgical field, and thus endoscopic techniques require specialized skills compared to the corresponding open surgical techniques. Endoscopic surgery may also refer to the use of a fiberoptic endoscope inserted through a body orifice into a body cavity such as the gastrointestinal tract, bronchi, uterus, or bladder. These applications of endoscopic surgery are not addressed by this policy.

 

While endoscopic surgery is a general term, laparoscopic, thoracoscopic, and arthroscopic surgery describe endoscopic surgery within the abdomen, thoracic cavity, and joint spaces, respectively. In most instances, the endoscopic technique attempts to duplicate the same surgical techniques and principles as the corresponding open techniques, with the only difference being surgical access. For example, laparoscopic cholecystectomy, performed since 1990, espouses the same surgical principles as open cholecystectomy. The advantages of endoscopic surgery include shorter hospital stays and more rapid recovery such that the patient may be able to return to work promptly. Disadvantages include a longer operative time, particularly if the surgeon is early on the learning curve for these new techniques.

 

Some endoscopic approaches entail novel surgical principles, and thus raise issues of safety and effectiveness apart from the safety and effectiveness of the endoscopic approach itself. For example, open herniorrhaphy is typically done from an inguinal approach, while laparoscopic herniorrhaphy involves a unique abdominal approach. In other procedures, the surgical dissection can be done entirely with endoscopic guidance, but the resulting surgical specimen may be too large to remove through the small trocar incision. Novel approaches have been devised to overcome this limitation. For example, in laparoscopic splenectomy or nephrectomy, the resected specimens are placed into a bag intra-abdominally, morcellated, and then removed through a small muscle-splitting incision. Similarly, laparoscopic colectomy specimens can be removed through either a muscle-splitting incision, or transanally for distal specimens. Surgeries can combine an open and laparoscopic approach; for example laparoscopic-assisted vaginal hysterectomy may entail a laparoscopic surgical dissection, with removal of the specimen through a vaginal incision similar to an open vaginal hysterectomy.

 

In most instances it is assumed that an endoscopic approach is a direct substitution for the corresponding open approach. However, the decreased morbidity of endoscopic surgeries in general may broaden the patient selection criteria for certain surgeries. For example, open gastric fundoplication is typically limited to those patients who have failed medical management with H-2 blockers and antimotility agents. Now, however, laparoscopic fundoplication may be considered an alternative to lifelong medical management. Similarly, open plantar fasciotomy is typically reserved for those symptomatic patients who have failed a prolonged attempt at conservative management. The decreased morbidity of an endoscopic approach may prompt a shortened period of conservative management.

 

Endoscopic, laparoscopic, and thoracoscopic CPT codes for which there are CPT codes for the corresponding open surgical procedure are summarized below. Not included are those CPT codes describing endoscopic diagnostic procedures and those describing arthroscopic procedures, with the exception of endoscopic carpal tunnel release and endoscopic plantar fasciotomy. The following table correlates the laparoscopic CPT code with the corresponding open procedure.

 

Laparoscopic Surgical (i.e., non-diagnostic) CPT Codes 
Laparoscopic CPT Codes  CPT Code Corresponding Open Procedure 
38120: splenectomy  38100: splenectomy 
38129: unlisted laparoscopy procedure, spleen   
38570: laparoscopic retroperitoneal lymph node sampling  38780: retroperitoneal transabdominal lymphadenectomy 
38571: laparoscopic bilateral total pelvic lymphadenectomy  38770: pelvic lymphadenectomy 
38572: laparoscopic bilateral total pelvic lymphadenectomy with peri-aortic lymph node sampling  38780: retroperitoneal transabdominal lymphadenectomy, extensive, including pelvic, aortic, and renal nodes 
38589: Unlisted laparoscopy procedure, lymphatic system   
43280: laparoscopic esophagogastric fundoplication  43324: esophagogastric fundoplasty 
43279: laparoscopic esophagomyotomy with fundoplasty (Heller myotomy) 43330: Esophagomyotomy (Heller type); abdominal approach
43289: Unlisted laparoscopy procedure, esophagus   
43651-52: laparoscopic transsection of vagal nerves, truncal or selective, respectively  43640-43641: truncal or highly selective vagotomy, respectively 
43653: laparoscopic gastrostomy, without construction of gastric tube  No identical CPT code; 43500 (gastrostomy; with exploration may be the closest) 
43653: laparoscopic gastrostomy, temporary  43830: gastrostomy, temporary 
43659: Unlisted laparoscopy procedure, stomach   
44200: laparoscopic enterolysis  44005: enterolysis 
44201: laparoscopic jejunostomy  44310: ileostomy or jejunostomy, non-tube 
44202: laparoscopic intestinal resection, with anastomosis
 

 
44203: each additional small intestine resection
 

 
44204: laparoscopic colectomy, partial, with anastomosis 
44140-44121: Colectomy partial, with anastomosis or colostomy, respectively 
44205: laparoscopic colectomy, partial, with removal of terminal ileum with ileocolostomy  44160: Colectomy, partial, with removal of terminal ileum with ileocolostomy 
44206: laparoscopic colectomy, Hartmann-type procedure  44143: Colectomy, partial, Hartmann-type procedure 
44207: laparoscopic colectomy, low pelvic anastomosis  44145: Colectomy, with low pelvic anastomosis 
44208: laparoscopic colectomy, partial, with coloproctostomy  44146: Colectomy, partial, with coloproctostomy 
44210: laparoscopic colectomy, total abdominal, without proctectomy  44150: Colectomy, total abdominal, without proctectomy 
44211: laparoscopic colectomy, total abdominal, with proctectomy with ileoanal anastomosis, creation of ileal reservoir, with loop ileostomy, with or without rectal mucosectomy  44152-44153: Colectomy, total abdominal, with proctectomy with ileoanal anastomosis, creation of ileal reservoir, with loop ileostomy, with or without rectal mucosectomy 
44212: laparoscopic colectomy, total abdominal, with proctectomy with ileoanal anastomosis, creation of ileal reservoir, with loop ileostomy, with or without rectal mucosectomy  44155: Colectomy, total abdominal, with proctectomy with ileoanal anastomosis, creation of ileal reservoir, with loop ileostomy, with or without rectal mucosectomy 
44238: Unlisted laparoscopy procedure, intestine (except rectum)   
44239 Unlisted laparoscopy procedure, rectum   
44970: laparoscopy, surgical, appendectomy  44950-60: appendectomy, as separate procedure, or for ruptured appendix 
44979: Unlisted laparoscopy procedure, appendix   
47370-71: laparoscopy, surgical ablation of one or more liver tumor(s) with radiofrequency or cryosurgery, respectively*  47380-82: Ablation open, of one or more liver tumors, radiofrequency or crysurgery, respectively*
 

 
47382: Ablation, one or more liver tumors, percutaneous, radiofrequency* 
*Radiofrequency and cryosurgical ablation of liver tumors considered investigational, when performed via an open procedure, laparoscopically or percutaneously. See policy No. 7.01.75. 
47560-61: laparoscopy, surgical; with guided transhepatic cholangiography, without or with biopsy, respectively  47500: injection procedure for percutaneous transhepatic cholangiography
 

 
74300: cholangiography; intraoperative with radiological supervision and interpretation
 

 
74320: cholangiography, percutaneous, transhepatic, radiological supervision and interpretation 
47562-64: laparoscopic cholecystectomy; any method, with cholangiography, or exploration of the common duct, respectively  47600-47610: cholecystectomy with cholangiography or exploration of the common bile duct, respectively 
47570: laparoscopic cholecystoenterostomy  47720: cholecystoenterostomy 
47579: unlisted laparoscopy procedure, biliary system   
49320: laparoscopy, abdomen, peritoneum and omentum, diagnostic  49000: exploratory laparotomy, exploratory celiotomy 
49321: laparoscopic biopsy of biliary system  variety of CPT codes corresponding to biopsy or aspiration of specific organs or tissue 
49322: laparoscopic aspiration of cavity or cyst  various CPT codes describing cysts in various locations, i.e., pancreas (48510), liver (47010), ovary (58805) 
49323: with drainage of lymphocele to peritoneal cavity  49062; drainage of extraperitoneal lymphocele to
 

 
peritoneal cavity, open 
49329; Unlisted laparoscopic procedure, abdomen, peritoneum and omentum   
49652: Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); reducible (new 2009) 49568: Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection
49653: ; incarcerated or strangulated (new 2009)  
49654: Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); reducible (new 2009)  
49655: ; incarcerated or strangulated (new 2009)  
49656: Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); reducible (new 2009)  
49657: ; incarcerated or strangulated (new 2009)  
49650-51: laparoscopic repair of initial, recurrent inguinal hernia, respectively  49495-49525: CPT codes vary according to patient age,
 

 
initial
, recurrent, or incarcerated hernia 
49659: Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy   
50541: laparoscopic ablation of renal cysts  No exact corresponding open procedure, but CPT code 50280 (Excision or unroofing of cysts of kidney)  
50542: laparoscopic ablation of renal mass lesion  50220-50240 nephrectomy code range 
50543: laparoscopic partial nephrectomy  50240: nephrectomy, partial 
50544: laparoscopic pyeloplasty  50400; pyeloplasty 
50545: laparoscopic radical nephrectomy  50230:nephrectomy, radical 
50546: laparoscopic nephrectomy  50220; nephrectomy 
50547: donor nephrectomy from living donor  50300; donor nephrectomy 
50548: laparoscopically assisted nephroureterectomy  50220; nephrectomy  
50549: unlisted laparoscopic produce, renal   
50945: laparoscopy, surgical ureterolithotomy  50610-50630; ureterolithotomy, various locations 
50947: laparoscopic ureteroneocystostomy with csytoscopy and ureteral stent placement  There is no CPT code that describes open ureteroneocystostomy specifically in conjunction with stent placement 
50948: laparoscopic ureteroneocystostomy without cystoscopy and stent placement  50780: ureteroneocystostomy 
50949: Unlisted laparoscopy procedure, ureter   
51990: laparoscopic urethral suspension for stress incontinence  51840: anterior vesicourethropexy, or urethropexy; simple 
51992: laparoscopic sling operation for stress incontinence  57288; sling operation for stress incontinence 
54690: laparoscopic orchiectomy  54520: simple orchiectomy 
54692: laparoscopic orchiopexy for intra-abdominal testis  54640-54650; orchiopexy 
54699: unlisted laparoscopy procedure, testis   
55550: laparoscopic ligation of spermatic veins for varicocele  55530-55535: excision of varicocele 
55559: unlisted laparoscopy procedure; spermatic cord   
58545-46: Laparoscopy, surgical, myomectomy, excision, less than or greater than 250 gm, respectively  58140, 58146: Surgical myomectomy, abdominal approach, less than or greater than 250 gm, respectively 
58550-52: laparoscopic vaginal hysterectomy for uterus 250 gm or less with or without removal of tube and/or ovary (addressed in policy 7.01.57)
 

 
58553-53: laparoscopic vaginal hysterectomy for uterus weighing greater than 250 gm with or without removal of tube and/or ovary (addressed in policy 7.01.57) 
58260-58262: Vaginal hysterectomy with or without removal of tube(s) and ovary(s) 
55866: laparoscopy, surgical prostatectomy, retropubic radical  55840: prostatectomy, retropubic radical 
58578: unlisted laparoscopy procedure, uterus
 

 
58660: laparoscopic lysis of adhesion 
58740: lysis of adhesion 
58661: laparoscopic removal of adnexal structure (partial or total oophorectomy and/or salpingectomy)  58940: total or partial oophorectomy
 

 
58700: complete or partial salpingectomy 
58662: laparoscopic fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method  49200-49201: excision or destruction by any method of intra-abdominal or retroperitoneal tumors or cysts or endometriomas 
58670-71: laparoscopic fulguration of oviducts  58600-58615: ligation or transsection of fallopian tubes 
58673: laparoscopic salpingostomy  58770: salpingostomy 
58672: laparoscopic fimbrioplasty  58760: fimbrioplasty 
58679: unlisted laparoscopy procedure, oviduct, ovary   
59898: unlisted laparoscopy procedure, maternity care and delivery   
60650: laparoscopic adrenalectomy  60540: adrenalectomy 
60659: unlisted laparoscopic procedure, endocrine system   

The following table summarizes CPT codes for endoscopic orthopedic procedures and thoracoscopic procedures with the CPT code for the corresponding open procedure.

Endoscopic/Thoracoscopic CPT Codes  CPT Code Corresponding Open Procedure 
Endoscopic Orthopedic Procedures 
29848: arthroscopic release of carpal tunnel ligament  64721: neuroplasty of median nerve at carpal tunnel 
29893: endoscopic plantar fasciotomy  28008: fasciotomy, foot and/or toe 
Thoracoscopic Procedures 
32601-32606: Thoracoscopy, diagnostic, with and without biopsy of a variety of structures   32035: Thoractomy, limited for biopsy of lung or pleura 
32650: pleurodesis  32005: chemical pleurodesis 
32651-2: partial or total pleural decortication, respectively  32320: decortication and parietal pleurectomy 
32653: removal of intrapleural foreign body  32150 removal of intrapleural foreign body 
32654: control of traumatic hemorrhage  32110: control of traumatic hemorrhage 
32655: excision-plication of bullae  32141: excision-plication of bullae 
32656: parietal pleurectomy  32310: parietal pleurectomy 
32657: wedge resection  32500: wedge resection 
32658: removal of clot or foreign body from pericardial sac  33020: pericardiotomy for removal of clot or foreign body 
32659: creation of pericardial window, or partial resection of pericardial sac for drainage  33025: creation of pericardial window or partial resection for drainage 
32660: total pericardiectomy  33030: subtotal or complete pericardiectomy 
32661: excision of pericardial cyst, tumor, mass  33050: excision of pericardial cyst or tumor 
32662: excision of mediastinal mass  39220: excision of mediastinal tumor 
32663: lobectomy, total or segmental  324800-32484: describes lobectomy procedures 
32664: thoracic sympathectomy  64809: sympathectomy, thoracolumbar 
32665: esophagomyotomy  43331: esophagomyotomy; thoracic approach 

 


 

Policy

The endoscopic procedures listed above may be considered medically necessary as an alternative to the corresponding open surgical procedures with the exception of laparoscopic radiofrequency or cryosurgical ablation of liver tumors. These procedures are considered separately in policy No. 7.01.75.

 


 

Policy Guidelines

A listing of patient selection criteria for each laparoscopic/thoracoscopic/arthroscopic/endoscopic procedure is beyond the scope of this policy. However, in general, candidates for such an endoscopic procedure should meet patient selection criteria for the corresponding open procedure; endoscopic procedures should not be considered an alternative to appropriate medical management. This may be of particular concern in laparoscopic fundoplication and endoscopic plantar fasciotomy when proposed before an adequate trial of medical management.

 


 

Benefit Application

BlueCard/National Account Issues

Physicians may request an increased level of reimbursement compared to the corresponding open procedure, based on the increased operating room (OR) time and the additional training and expertise required to perform endoscopic surgery. However, the increased OR time may be compensated for by the decreased hospitalization and follow-up period. Each plan should consider whether to treat reimbursement of endoscopic, laparoscopic, or arthroscopic procedures differently than the corresponding open procedures.

 


 

Rationale

American Medical Association. Common Procedural Terminology Year 2002

 

Codes

Number

Description

CPT codes    See Description section, above 
ICD-9 Procedure  04.43  Release of carpal tunnel 
  05.29  Other sympathectomy and ganglionectomy 
  07.22–07.30  Adrenalectomy code range 
  32.21  Plication of emphysematous bleb 
  32.29  Other local excision o r destruction of lesion or tissue of lung 
  32.3  Segmental resection of lung 
  32.4  Lobectomy of lung 
  33.39  Other surgical collapse of lung 
  34.3  Excision or destruction of lesion or tissue of mediastinum 
  34.4  Excision or destruction of lesion of chest wall 
  34.09  Other incision of pleura 
  34.51  Decortication of lung 
  34.59  Other excision of pleura 
  34.6  Scarification of pleura 
  34.92  Injection into thoracic cavity 
  37.12  Other local excision or destruction of lesion or tissue of lung 
  37.31  Pericardiectomy 
  37.33  Excision or destruction of other lesion or tissue of heart 
  40.11  Biopsy of lymphatic structure 
  40.3  Regional lymph node excision 
  41.43  Partial splenectomy 
  41.5  Total splenectomy 
  42.7  Esophagomyotomy 
  43.19  Temporary gastrostomy 
  44.01–44.03  Vagotomy, code range 
  44.66  Other procedures for creation of esophagogastric sphincteric competence (includes fundoplication) 
  45.61–45.63  Other excision of small intestine, code range 
  45.71–45.79  Partial excision of large intestine, code range 
  45.8  Total intra-abdominal colectomy 
  46.01–46.04  Exteriorization of intestine, code range 
  46.31–46.39  Enterostomy, code range 
  47.01  Laparoscopic appendectomy 
  51.23  Laparoscopic cholecystectomy 
  51.24  Laparoscopic partial cholecystectomy 
  51.32  Anastomosis of gallbladder to intestine  
  51.51  Exploration of common bile duct 
  53.00  Unilateral repair of inguinal hernia, not otherwise specified 
  53.01  Unilateral repair of direct inguinal hernia 
  53.10  Bilateral repair of inguinal hernia  
  54.21  Laparoscopy 
  54.23  Biopsy of peritoneum 
  54.24  Closed biopsy of intra-abdominal mass 
  54.4  Excision or destruction of peritoneal tissue 
  54.51  Laparoscopic lysis of peritoneal adhesions (includes laparoscopic enterolysis) 
  59.03  Laparoscopic lysis of perirenal or periureteral tissue 
  59.12  Laparoscopic lysis of perivesical adhesions 
  62.3  Unilateral orchiectomy 
  62.41–62.42  Removal of testes, code range 
  63.1  Excision of variocele and hydrocele of spermatic cord 
  65.13  Laparoscopic biopsy of ovary 
  65.24  Laparoscopic wedge resection of ovary 
  65.25  Other laparoscopic local excision or destruction of ovary (includes partial oophorectomy) 
  65.31  Laparoscopic unilateral oophorectomy 
  65.41  Laparoscopic unilateral salpingo-oophorectomy 
  65.53  Laparoscopic removal of both ovaries at same operative episode 
  65.54  Laparoscopic removal of remaining ovary 
  65.63  Laparoscopic removal of both ovaries and tubes at same operative episode 
  65.64  Laparoscopic removal of remaining ovary and tube 
  65.76  Laparoscopic salpingo-oophoroplasty 
  65.81  Laparoscopic lysis of adhesions of ovary and fallopian tube 
  66.02  Salpingostomy 
  66.21–66.22  Bilateral endoscopic ligation and crushing, or division of fallopian tubes, code range 
  66.79  Other repair of fallopian tubes 
  68.15  Closed biopsy of uterine ligaments 
  68.16  Closed biopsy of uterus 
  68.29  Other excision or destruction of lesion of uterus 
  68.51  Laparoscopically assisted vaginal hysterectomy (LAVH) 
  83.14  Fasciotomy 
  87.53  Intraoperative cholangiogram 
ICD-9 Diagnosis    Refer to policy for corresponding open procedure 
HCPCS  No codes   
Type of Service  Surgery 
Place of Service  Inpatient 

 


 

Index

Endoscopic Surgery, General
Laparoscopic Surgery, General
Thoracoscopic Surgery, General

 


 

Policy History

Date Action Reason
04/01/98 Add to Administrative Section New Policy
11/15/98 Replace policy Updated for new CPT codes
11/01/99 Replace policy Updated for new CPT codes; policy unchanged
10/15/00 Replace policy Updated for new CPT codes; policy unchanged
12/18/02 Replace policy Updated for new CPT codes; policy unchanged, cross-referenced to separate policy on laparoscopic radiofrequency and cryosurgical ablation of liver tumors. Policy will no longer be scheduled for routine review.