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Maarit Posted Thu 24th of February, 2011 02:34:40 AM

I need help in deciding how to bill for a problematic appendectomy: A) A surgeon was performing a hysterectomy and encountered a pelvic mass which was adhered to the rectum and appendix. Our surgeon was asked for a consult, after which he performed the lysis of adhesions. OP report states "upon separation of the of the appendix from the mass it was unclear if the tip of appendix was compromised. Therefore an appendectomy was performed." The pathology states the appendix was normal. Our surgeon states the removal was for an "indicated purpose", because you cannot leave an injured appendix behind. Our surgeon was not listed as an assistant and he did not open or close. The trouble is: 1) lysis of adhesions is considered a part of the major surgery 2) 44955 is an add on code (appendectomy). Could I code this with 44950 with mod. 52? And what would the Dx be, since the appendix was healthy? 614.6?
B) PT is admitted with abdominal pain. The US of appendix looks unclear. Surgeon decides to go investigate laparoscopically. OP report states "appendix looks normal", but he removes it because the US looked suspicious. Can we bill for 44970 with Dx of abdominal pain and 793.6, since pathology states the appendix is normal? I appreciate hearing your thoughts on these.

SuperCoder Answered Fri 25th of February, 2011 06:56:41 AM

An incidental appendectomy performed at the time of another intra-abdominal surgery is not reported separately. For those rare instances where it is necessary to report incidental appendectomy, append modifier 52.
Case A: Code for hysterectomy, 44955-52
Case B: There is a medical necessity issue involved here. The Ultrasound may have shown the necessity to proceed with the surgery to justify for 44970, but during surgery if the surgeon says the appendix looks normal, then we need to discuss with the surgeon that if the Ultrasound finding should override what the surgeon evaluates during surgery ? If yes, then we code for appendectomy as usual. But, if it doesn't override surgeon's finding during surgery, then the surgeon has the option to discontinue the surgery. In such a case, removing appendix is questionable, and so is its reimbursement.

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