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Planned Appendectomy w/ an incidiental finding of Pelvic endometriosis

Stephanie Posted Fri 12th of April, 2019 11:44:30 AM
Hi my provider planned for an appendectomy and after removal of the appendix. After the appendix removal she found pelvic wall foic endometriosis. She billed 58662 for that 44970 for the appendectomy. I billed for both and the insurance only paid on 58662 and not the 44970 even though I had a -59 on it. Do I have the correct code for the pelvic for the pelvic endometriosis and should I have only billed 44970 since the other procedure was an incidental finding? Here's the note: Ports made and trocars placed. A 5mm suprapubic port and 5mm port between pubis and umbilicus were placed under direct visualization. The appendix was acutely inflamed hypermic and edematous without evidence of perforation or exudate. The base the appendix was grasped and a window was crated in the mesoappendix, a 45 mm Endo-Gia tissue load stapler was fired across the base of the appendix. A vascular reload was fired across the mesoappendix. The appendix was then brought out through the umbilical trocar. The right lower quadrant was irrigated. The staple lines were inspected and excellent homeostasis was achieved with careful cauterization of the staple lines. There was incidental finding or right lateral pelvic wall foci of endometriosis. The larger focus, measuring 5mm was excised an sent for pathology. The second focus was obliterated w/ cauterization. Bilateral ovaries and tubes were inspected and were within normal limits. There was also a small a mount of "gunpowder" appearance of the cul-de-sac. Right lower quadrant and pelvis was irrigated; peritoneal leavage was performed. Pneumpoperitoneum was desufflated. Trocars removed sutures used to close the umbilical fascial incision.
SuperCoder Answered Mon 15th of April, 2019 05:22:51 AM

Hi Stephanie,

As the doctor performs appendectomy and there was an incidental finding of pelvic wall foic endometriosis. The only code that will be used for the above procedure will be 44970 and excision of endometriosis will be included. However, if the provider feels excision of endometriosis added significant work and time along with the primary surgical procedure then we may use modifier 22 (Increased procedural service) with the CPT code. Feel free to ask for any further query.

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