Clinically Significant Hepatopathology Detected At Cholecystectomy Dramatically Increases Billing

Abstract

Abstract Introduction/Objective Incidental hepatic tissue obtained via cholecystectomy is generally minute and inconsequential. For these reasons, the hepatic tissue is bundled with the gallbladder and cannot invoke additional billing. However, hepatic tissue that is very large or that harbors significant hepatopathology has clinical utility and could justify additional billing. We hypothesized that such incidental hepatic tissue would dramatically increase billing because the liver is billed at a higher level of complexity than the gallbladder and requires cytochemistry for evaluation. Methods We retrospectively reviewed pathology reports, slides, and codes from 9 specimens from cholecystectomy that contained hepatic tissue that was grossly evident or that demonstrated significant hepatopathology. Our billing department with decades of experience but without medical training codified the reports using the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and Current Procedural Terminology (CPT), blinded to our study. Results The patients included 5 women and 4 men, ages 18 to 72 years. Five specimens contained very large pieces of liver 0.8 cm to 2.2 cm long and 0.3 cm to 1.8 cm thick. Diagnoses included nonalcoholic fatty liver disease or steatohepatitis (6 specimens), de novo alpha-1 antitrypsin deficiency (2 specimens), de novo sinusoidal amyloidosis (1 specimen), hemosiderosis (1 specimen), and obstruction (1 specimen). Some specimens demonstrated multiple diagnoses. Only ICD-10 codes K76.0 (6 specimens) and K75.81 (2 specimens) were generated, corresponding to nonalcoholic fatty liver disease and steatohepatitis, respectively. ICD-10 codes were omitted for 1 specimen. Although all specimens generated CPT codes 88312 (20 charges) and 88313 (14 charges), corresponding to cytochemistry, none generated CPT code 88307, corresponding to the liver. Conclusion Incidental hepatic tissue obtained via cholecystectomy dramatically increases billing, but significant hepatic findings and exceptions to coding principles must be clearly conveyed to billing departments to ensure proper coding.