Point to remember for Cpt code for Surgical laproscopic open perforated appendectomy

Cpt code for Surgical laproscopic open perforated appendectomy
An appendectomy in progress (Photo credit: Wikipedia)
CPT and payer guidelines frequently bundle appendectomy to other abdominal procedures the surgeon performs during the same session. In my previous post we have learn drainage collection through assitance of vaccum which were as complicated as Surgical appendectomy. Today we learn about cpt code for appendectomy in detail. Their is rule for coding appendectomy with other surgical procedures of abdomen. So as a rule, you can separately report and be paid for appendectomy when the procedure meets two requirements:

1.     There is a documented problem with the appendix.
2.     Any other procedures during the same session do not relate directly to the right colon.

CPC Practice Exam - Medical Coding Study Guide Please Click Here!

Don't Expect Reimbursement for 'Healthy' Removal

Medicare will not pay separately for the removal of a healthy appendix.
Background: Surgeons may perform appendectomies (particularly on younger patients) during the course of more extensive abdominal procedures. Although this practice is not as popular as it was in the past, many surgeons still remove a healthy appendix simply because they have already opened the patient and removing the appendix eliminates a potential subsequent health problem.
To avoid paying for removal of healthy appendixes, many payers now want to see proof (such as an operative report) that an appendectomy performed during the same session as another procedure was medically necessary.
These tips are really important for Certification exams like CPC, you can go through sample CPC questions here which will surely help in clearing CPC exam. You will clear most of your doubts about CPT code for appendectomy in this article.

Separate Dx for CPT code for appendectomy

you should apply a separate diagnosis to prove to the payer that an appendectomy is medically necessary. If you cannot supply such a separate diagnosis, chances are that the removal isn't required because of immediate health concerns.

If the surgeon doesn't have a specific diagnosis before opening the patient, then you should report the applicable signs and symptoms. If the appendix returns from the pathology lab showing disease, you should also provide that information to the payer.

If a patient has a gallbladder or ovarian problem, for example, and the surgeon finds appendicitis as well and performs an appendectomy, you should report +44955 (Appendectomy; when done for indicated purpose at time of other major procedure [not as separate procedure][List separately in addition to code for primary procedure]) in addition to the primary procedure performed -- as long as there is a separate diagnosis (that is, appendicitis), sign or symptom, or pathology that relates specifically to the appendix.

Why: Note the use of "indicated purpose" in the descriptor for +44955. This means that there must be a separate, medically necessary diagnosis or signs and symptoms to justify the appendectomy.

Example 1: A surgeon performs a diagnostic laparotomy to determine the source of a female patient's abdominal pain and finds a ruptured ovarian cyst on the left and an inflamed appendix on the right. The surgeon then performs a left oophorectomy (58940, Oophorectomy, partial or total, unilateral or bilateral) and also removes the appendix.

When the pathology report returns, appendicitis is indicated. Therefore, you may report the appendectomy using +44955.

Caution: If the pathology report had returned negative, however, you should not separately report the appendectomy (because there is no diagnosis to support the procedure).

Example 2: Surgeons often remove the appendix during bariatric surgery (for example, 43846, Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb [150 cm or less] Roux-en-Y gastroenterostomy).

In this case, you may report removal of the appendix separately -- as long as the surgeon encounters evidence of an inflamed appendix (in other words, medical necessity must support the removal of the appendix). Unless the appendix appears abnormal (with scarring and/or old inflammatory changes, for example), the removal is incidental to the surgery, and you should not report the appendectomy separately.

Recognize When cpt code for Appendectomy Isn't Separate

Finding appendicitis in a patient during the course of another procedure is not a common occurrence.
More frequently, for instance, a patient may have a bowel obstruction and appendicitis -- in fact, the appendicitis may be the cause of the bowel obstruction.

If the obstruction requires a right colectomy (44140, Colectomy, partial; with anastomosis), you cannot separately report the appendectomy because the appendix is simply an extension of the cecum at the bottom of the right colon, and the surgeon will therefore remove it along with the rest of the resected colon.
In this case, therefore, the appendectomy is not a "separate procedure," but simply included as part of a more extensive surgery.

Consider Other Appendectomy Possibilities

Code +44955 is not your only choice for appendectomy. Depending on the circumstances, you may potentially

Report Only Successful Procedure for Conversions
Remember: If the surgeon begins a procedure laparoscopically and must convert to an open procedure to finish, you can only report the successful (open) procedure.
This would mean that if the surgeon begins a laparoscopic appendectomy (44970) but, for patient safety or other reasons, must convert the procedure to an open appendectomy (44950), you should only report 44950.
In addition: When the surgeon converts from an endoscopic to an open procedure, you should attach V64.41 (Laparoscopic surgical procedure converted to open procedure) as a secondary diagnosis.

Select from three additional codes:
44950-- Appendectomy
44960 -- ... for ruptured appendix with abscess or generalized peritonitis
44970 -- Laparoscopy, surgical, appendectomy

You should select 44950 when appendectomy is the only procedure the surgeon performs during the operative session.

If the surgeon removes only the appendix laparoscopically, you should instead select 44970.

Important: You should report 44950/44970 only if the patient's appendix has not burst.
If the surgeon removes a ruptured appendix, you should report 44960 (unless the surgeon also performs right colectomy, as described above). Code 44960 includes both the removal of the ruptured appendix as well as debridement and lavage of the area to make sure all infected tissue and fluid are removed.

When reporting 44960, you should attach a diagnosis relating to both the appendectomy (appendicitis) and debridement and lavage (peritonitis).

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