Appendectomy with negative path

VRcoder29

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I have a patient who came in through the ED with a positive CT of the lower quadrant signifying possible appendicitis . The patient is taken to the OR , The physician does a laparoscopic appendectomy with abdominal lavage , he find the patient has a hemorrhagic ruptured ovarian cyst, this is why he done the lavage (49320) , to clear out the caviety from blood.
The appendix path comes back as completely normal .

My question : The intent of this surgery was to remove the appendix because of possible appendicitis , but it ended up being negative in the end .
As far as I know, the surgeon can go ahead and bill for the laparoscopic appendectomy , however there is a strong possibility of denial .
I have googled, and researched local websites and I can't find any solid proof of the "rules" for when something like this happens. Is it ok to bill this procedure?
Can anyone show me any proof of why this is ok?
 

KANDREWS131

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I don't really have any documentation showing you can bill this, but we have billed it in the past, and just appeal if/when it gets denied. We bill with the patient's symptoms since there's no appendicitis dx, which helps with the appeal. This shows the patient had all of the symptoms of appendicitis, making the procedure medically necessary at the time.
 

VRcoder29

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ok , thank you for the input .
I am having issues with the pre authorization team disagreeing with me , but I don't really know what else to tell them . I don't have any written proof otherwise to give them .
 

mitchellde

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I use dx code Z03.89 for condition ruled out followed by the symptom code. then you would use the ruptured cyst code last since it is an incidental finding and make sure to link it only to the lavage code and link the other two to the appendectomy code. I have never had any issue with this.
 

VRcoder29

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I do not think Z03.89 is appropriate, especially since the patient was in OBSV for the Abdominal pain, which was technically caused by the ruptured ovary ...
 

mitchellde

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The reason for the surgery was a possible appendicitis which was then ruled out by the surgery, the ruptured ovary was an incident finding and not the reason for the surgery. In my opinion it fits the documentation provided, and it does not change the scenario.
 
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