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Question: A patient presented with intermittent right lower quadrant (RLQ) pain, mild nausea, and a low-grade fever. A radiologist performed transabdominal and transvaginal ultrasound exams and CT of the abdomen and pelvis with intravenous (IV) contrast, which showed a borderline-caliber appendix without definite periappendiceal stranding. The physician ordered a diagnostic laparoscopy to inspect the appendix, terminal ileum, cecum, pelvis, both ovaries and fallopian tubes, and the gallbladder region. The appendix appeared grossly normal but given the persistent RLQ pain and an indeterminate CT, the surgeon performed a laparoscopic appendectomy.

Can we bill the diagnostic laparoscopy for the RLQ pain and the laparoscopic appendectomy?

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Answer: No, you can report both the diagnostic laparoscopy and laparoscopic appendectomy procedures separately. You should only report 44970 (Laparoscopy, surgical, appendectomy) for the surgery. This code inherently includes the work of the diagnostic laparoscopy, so you cannot assign 49320 (Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)) as well.

The CPT^® guidelines state that surgical laparoscopy “always includes diagnostic laparoscopy.” At the same time, the National Correct Coding Initiative (NCCI) edit pairs lists 49320 as a column 2 code of 44970, which means 49320 is bundled into 44970 and you cannot unbundle the two codes to report them separately.

Mike Shaughnessy, BA, CPC, Production Editor, AAPC