Don’t Burst Open Your Claims With Appendectomy Reporting Mistakes

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Who would have guessed that reporting an appendectomy could be complicated? But incorrectly report the procedure excising that little blind pouch that hangs off the end of the cecum — and you could find your provider getting significantly underpaid. Here are three tips that will help you correctly report this common general surgical procedure.

1. Justify Medical Necessity for Appendectomy

Back in the day, some 30 or so years ago, I remember often seeing op reports for hysterectomies with incidental appendectomies. It was basically a case of “while we’re in there, I’ll take out your appendix for you so you never have to worry about appendicitis.” Not so any more. Today, if your surgeon removes a healthy appendix — or even worse, removes a diseased one but forgets to document the symptoms, gross appearance, or pathology that necessitated the removal — you can forget about getting reimbursed for the service.

Look to the operative note’s “indications for procedure” section for a description of why your surgeon removed the appendix. You can get additional coding ammunition from the pathology report if it’s available at the time you drop your bill.

A diagnosis justifying the medical need for an appendectomy could be symptoms like right lower quadrant abdominal pain (R10.31, Right lower quadrant pain). Maybe the surgeon says the patient demonstrated exquisite tenderness to palpation over McBurney’s point, the area in the abdomen’s right lower quadrant that corresponds closely to the appendix’s attachment to the cecum. Your surgical or pathology report might even document a definitive diagnosis such as K35.- (Acute appendicitis).

2. Pick the Right Standalone Code

When a surgeon performs a primary appendectomy, meaning that removal of the appendix was the sole reason for the surgery, choose one of these CPT® codes:

  • 44950, Appendectomy
  • 44960, Appendectomy; for ruptured appendix with abscess or generalized peritonitis
  • 44970, Laparoscopy, surgical, appendectomy.

44950 and 44960 are for open primary appendectomies; use 44960 only for an appendix that has perforated or ruptured, and/or for diffuse peritonitis. The ICD-10 code for that condition is K35.2 (Acute appendicitis with generalized peritonitis).

At the hospital where I work, our surgeons perform almost all their appendectomies laparoscopically. These surgeons’ coders would report 44970. But what happens when the surgeon performs a lap appy and the appendix is ruptured or peritonitis is present? You couldn’t report 44960 when the surgery was laparoscopic, since 44960 is reserved for open procedures. So the best bet would be to report 44970 for a laparoscopic appendectomy, and append modifier 22 (Increased procedural services) to account for the extra work involved with a perforated appendix removal.

3. Add-On Appendectomy Could Be Reported

We talked about incidental appendectomies at the beginning of this blog, discussing how such procedures are not reportable or reimbursable. And they aren’t. But what if a surgeon is performing another major procedure, a hysterectomy for example, and notices that the appendix appears grossly inflamed, gangrenous, or perforated, then chooses to remove it?

In this case, you should report an add-on code for the appendectomy. For an open procedure, you’d 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]).

For a laparoscopic appendectomy performed in addition to another major procedure, you’d have to report your regular laparoscopic appendectomy code of 44970, adding modifier 59 (Distinct procedural service) or other appropriate modifier.

How About You?

Got any tips we missed on appendectomy coding? Let us know in the comment box below.

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About 

Susan taught health information and healthcare documentation at the community college level for more than 20 years. She has a special love for medical language and terminology. She is passionate about ensuring accurate patient healthcare documentation through education. She has a master's degree in healthcare administration, is a certified healthcare documentation specialist, and serves as immediate past president for the Association for Healthcare Documentation Integrity (AHDI).

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    […] Who would have guessed that reporting an appendectomy could be complicated? But incorrectly report the procedure excising that little blind pouch that hangs off the end of the cecum — and you could find your provider getting significantly underpaid. Here are three tips that will help you correctly report this common general surgical procedure. Source URL:- http://goo.gl/l0L0ey  […]

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