General Surgery Coding Alert

Reader Question:

Look for Separate Appendectomy

Question: While performing an open gallbladder removal, the surgeon noted localized peritonitis associated with acute appendicitis. The surgeon then removed the appendix. Is the appendectomy bundled with the gallbladder removal for coding purposes?

Tennessee Subscriber

Answer: You can separately code the cholecystectomy and the appendectomy in this case. Although you must bundle “incidental” appendectomy with other abdominal procedures, you can separately bill the appendix removal in many cases when the surgeon notes distinct pathology.

Report this case as 47600 (Cholecystectomy) and +44955 (Appendectomy; when done for indicated purpose at time of other major procedure (not as separate procedure) (List separately in addition to code for primary procedure)).

Caution: Don’t bill 44950 (Appendectomy) in this case. Add-on code +44955 is a more accurate code, plus Correct Coding Initiative (CCI) edits bundle 44950 as a column 2 code for 47600 with a “0” modifier indicator, meaning that you should never use a modifier to override the edit pair.