Let me get some clarification:
44204 was the primary procedure. The appendix was also removed but was normal and incidental? If that's the case, then the appendectomy is not billed at all.
IF there was a medical indication for the appendectomy and appropriate, 44970 (with -59, -XS, -XU) is for laparoscopic appendectomy.
Thank you for your reply! That's initially what I thought until I read the code for +44955 (had this been an open procedure, I would have agreed with the coder since the tip is to code this add-on code when the appendix is normal and removed in addition to the primary major procedure). I really appreciate your help and knowledge!! =)
The coder billed out:
44204, 52 | D12.0
44979, 51 | D12.1
Box 19 states "52 MOD No Anastamosis & 44979 REF 44955"
Here is the operative note if you'd like to review for more clarification:
Pre-operative Diagnosis: Appendiceal orifice polyp
Post-Op Diagnosis: Same
Procedure: Laparoscopic Appendectomy and Partial Cecectomy
Anesthesia: General Endotracheal
Specimens: appendix, partial cecectomy
Complications: None
Indications: This is a 64yr yo male admitted for resection of appendiceal
orifice polyp found on colonoscopy.
Findings: ileocecal valve opposite appendiceal orifice
Procedure in Detail:
After informed consent was obtained from the patient, the patient was taken to
the operating room and placed in supine position. A timeout was performed.
Preoperative antibiotics had been administered. The anterior abdomen was prepped
and draped in a sterile fashion.
A supraumbilical incision was made and carried down to the fascia. The fascia
was retracted anteriorly with a kocher clamp. Stay sutures were placed in the
fascia. The fascia was retracted anteriorly and incised under direct vision. The
peritoneum was carefully opened under direct vision. A 12 mm port was placed
into the abdomen. Then 15 torr of CO2 pneumoperitoneum was then achieved. An
upper midline 5mm, a suprapubic 5 mm port and a left lower quadrant 5 mm port
were then placed under direct vision. The patient was rolled with head down, and
the cecum was identified. The appendix was also identified and appeared normal
from the outside. The cecum was mobilized from lateral to medial. The ileocecal
valve was noted to be across from the appendiceal orifice allowing for the polyp
to be excised without an ileocolic resection. The mesoappendix was taken with
cautery. A linear dividing GIA stapler was then placed across the base of the
cecum. This required three fires. The appendix and base of the cecum were then
placed in an EndoCatch bag and brought through the umbilical port site.
The umbilical port was replaced. The area was irrigated and suctioned and
carefully inspected for hemostasis. With adequate hemostasis, and the irrigant
fluid removed, the pneumoperitoneum was released. The fascia at the umbilicus
was closed using a figure-of-eight 0 Vicryl. The port sites were infiltrated
with Marcaine. The skin was closed with subcuticular 4-0 Vicryl and
Steri-Strips. The patient tolerated the procedure well, returned to the recovery
room in stable condition.
