Know How to Code a Ruptured Appendix With Open Conversion
Question: During a laparoscopic appendectomy for a patient presenting with classic signs of appendicitis (including sudden periumbilical pain that localized to the right lower quadrant and nausea), the surgeon discovered a ruptured appendix with widespread inflammation in the abdominal cavity. Due to these findings, the surgeon converted the procedure to an open appendectomy. The operative note indicates that debridement and lavage were performed to remove infected tissue and fluid; however, there is no documentation of a perforation or abscess. How should I code this procedure? Tennessee Subscriber Answer: In this case, you should report only the open appendectomy since the surgeon converted from a laparoscopic to an open approach. According to coding guidelines, when a laparoscopic procedure is converted to open, only the completed (more extensive) procedure should be reported. Therefore, report CPT® code 44960 (Appendectomy; for ruptured appendix with abscess or generalized peritonitis). Do not report the laparoscopic code 44970 (Laparoscopy, surgical, appendectomy), as it was not the completed approach. Although the surgeon performed debridement and lavage, these services are considered included in the work of a ruptured appendectomy and should not be reported separately with a code like 49084 (Peritoneal lavage, including imaging guidance, when performed). For diagnosis coding, report K35.200 (Acute appendicitis with generalized peritonitis, without perforation or abscess) to reflect the ruptured appendix and associated inflammation. Additionally, report Z53.31 (Laparoscopic surgical procedure converted to open procedure) as a secondary diagnosis to indicate the change in surgical approach. Suzanne Burmeister, BA, MPhil, Medical Writer and Editor
