Code Anesthesia for Emergency Appendectomy with Severe Systemic Disease
Question: A 45-year-old patient with poorly controlled Type 2 diabetes and hypertension presents to the emergency department with acute appendicitis and undergoes an emergency laparoscopic appendectomy. How do I determine the correct anesthesia service code? Codify Subscriber Answer: First, you’ll need to identify the surgical code. The CPT® code for a laparoscopic appendectomy is 44970 (Laparoscopy, surgical, appendectomy). Next, check the American Society of Anesthesiologists (ASA) Crosswalk to Anesthesia; you’ll find that lower abdominal laparoscopic procedures crosswalk to 00840 (Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; not otherwise specified). Next, you’ll assign physical status modifier: The patient has poorly controlled chronic conditions, which constitutes a severe systemic disease. You’ll report this with physical status modifier P3 (Patient with severe systemic disease). As the situation constitutes an emergency, you can add the emergency modifier or code. In CPT® coding, this is billed with add-on code +99140 (Anesthesia complicated by emergency conditions). This leads you to your final code selection: 00840-P3 and +99140. Jen Methax, CPC, Consultant, Pinnacle Enterprise Risk Consulting Services 
