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Laparoscopic assisted open appendectomy

Dawn C Posted Thu 08th of January, 2015 12:18:44 PM

Please see the below note. I have suggested that this be billed as 44970 but was told it should be 44950. What are you thoughts on correct billing based on this operative dictation.

Procedural details: The patient was brought to the operating room and placed supine on the OR table. Endotracheal intubation and general anesthesia were obtained, left arm was tucked, abdomen was prepped and draped in standard fashion. A final time our confirmed patient identity and surgical site. Preoperative antibiotics were administered. A longitudinal incision was made in the middle of the umbilicus and, using blunt dissection, the anterior fascia was identified. The umbilicus was elevated with a Kocher clamp and stay sutures of 0 vicryl were placed laterally along the midline. The fascia was opened using a 15 blade and the peritoneum was entered bluntly with a finger. A 12 mm Hassan trocar was placed. An operative laparoscope was placed into the abdominal cavity after insufflation had been obtained. We confirmed no injury to underlying bowel. The appendix was easily identified, grabbed with graspers, delivered into the umbilical wound after trocar removed. The fascial incision was extended to allow evisceration of the cecum into the operative field. The mesoappendix was isolated off the appendix and tied with two silk sutures, cut between sutures. We identified the base of the appendix and placed an endoGIA surgical stapler across it, transecting it. After inspection, we decided there was still some residual proximal appendix, so this was re-delivered out of the abdominal wound and transected with a surgical stapler once more. Upon delivery back into the abdominal cavity, some bleeding was noted along the base of the cecum. In order to apply surgical clips, an additional left lower quadrant 5 mm port was placed. Clips were deployed adjacent to the staple line. Once hemostasis was achieve, we deflated the abdomen and removed both ports. Fascia in the umbilical wound was closed with figure of 8 sutures using 0-vicryl. Skin was left open and a sterile dressing was applied. Skin in the left lower quadrant incision was closed with a single Monocryl suture. Patient was awakened from general anesthesia, tolerated the procedure without problems.

SuperCoder Answered Thu 08th of January, 2015 23:34:09 PM

You should code open appendectomy only using code 44950.

Thanks !!

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