7/23/18 – Upper vs. Lower Abdomen

We struggle sometimes with determining if a procedure should be coded as upper vs lower abdomen. Do you have any tips?

  Background: Every anesthesia code is associated with multiple surgical procedures that can be performed in that anatomic area. CPT® includes 14 codes for upper abdominal anesthesia and 25 codes for lower abdominal anesthesia. Two prime examples are:

  • 00790 — Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; not otherwise specified
  • 00840 — Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; not otherwise specified.

  Dividing line: Most follow the rule that the dividing line is the umbilicus.  Although the point of incision can point you toward the correct upper/lower answer, that isn’t always the case. Instead, focus on where the procedure is performed more than the incision point.

  Caution: Also distinguish between exploration and the actual procedure. The pelvic area might be explored because of trauma, along with a small bowel resection. In that case you’ll code the procedure as upper abdomen because the lower area was only explored and more than half the surgery was focused on resecting the small bowel.

 

When you’re coding for procedures in the small intestine, the American Society of Anesthesiologists considers “upper abdomen” to be anything from the colon through the sigmoid colon. Procedures focusing specifically on the sigmoid or rectum are considered “lower abdomen.”


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