General Surgery Coding Alert

Question: When the surgeon discovers appendicitis and performs an appendectomy during the primary procedure, such as an open cholecystectomy, I understand that we should  use +44955 instead of 44950. But what if the primary procedure is laparoscopic -- should we still use +44955 for an add-on appendectomy?

Iowa Subscriber

Answer: No, you should not use +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]) for a laparoscopic "add-on" appendectomy. If circumstances warrant billing a separate laparoscopic appendectomy, you should report 44970 (Laparoscopy, surgical, appendectomy) instead.

Caution: Abdominal surgery usually includes an incidental appendectomy. You should add a separate appendectomy code only if you meet both of the following criteria:

The appendix shows distinct pathology that prompts the surgeon to remove it, the surgeon and/or pathology report documents the condition

Other procedures during the same session do not relate directly to the right colon.

CPT puts it this way: "Incidental appendectomy during intra-abdominal surgery does not usually warrant a separate identification."

When your general surgeon performs a medically necessary open appendectomy at the same time as another open abdominal procedure, you'll turn to +44955. You should always use +44955 in addition to the primary procedure performed.

Study lap appy example: The surgeon performs laparoscopic gallbladder removal (47562, Laparoscopy,surgical; cholecystectomy). While performing that procedure, the surgeon finds appendicitis and removes the appendix as well. You should report 44970 instead of +44955 in this case.

Watch edits: The Correct Coding Initiative edits list 44970 as a column 2 (component) code to multiple codes from the surgical laparoscopy CPT sections for esophagus, stomach, bariatric surgery, intestines, rectum, liver, billiary tract, and abdomen. These edits all show a modifier indicator of "1," meaning that you can override the edit pairs when circumstances warrant. To code the multiple scope procedures together and override the edit pair with modifier 59 (Distinct procedural service), you should meet one of the following requirements:

The surgeon performed the second procedure in another location

The surgeon performed the second procedure at a different session (another time on the same date)

The first procedure led to the decision to perform the second procedure.