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incidental appy

  1. #1
    Default incidental appy
    Medical Coding Books
    I am stumped. My doctor was called in by another physician intra-operatively to take out an enlarged and (appeared) infected appendix. The pathology later revealed no disease in the appendix. He did a laparoscopic appy, so not sure which CPT to use. (If open I would use 44955).

    Also, diagnosis code: not sure where to go with that. He was not called in specifically for abdominal pain, etc. but for what appeared to both surgeons to be a diseased appendix.

    OP Note:
    This was an intraoperative consultation on a 37-year-old female who has had right lower quadrant pain. She was undergoing laparoscopy for endometriosis and Dr. ___appreciated that the appendix looked enlarged. Certainly, it did look enlarged and injected. Therefore, I was asked to come to the operating room. There was already an umbilical port in place as well as a left lower quadrant port. I placed a third 5 mm trocar in the suprapubic region under direct visualization after injecting local anesthetic. I then turned my attention to the appendix. This was readily identified. I used the Harmonic scalpel to divide the mesoappendix and then a 35 mm Endo GIA stapler to fire across the base of the appendix. The appendix was removed with an Endopouch bag and then I reinforced the staple line with a 5 mm clip applier where there was a small bleeding vessel. This secured it nicely. I suction irrigated out the blood and the patient tolerated the procedure well. I will turn the case back over to Dr. ____.

  2. #2
    Smile 44970/543.9
    Since Dr. added a 3rd trocar, I would use 44970 and 543.9 because both surgeons believed it was diseased eventhough the path report later confirmed otherwise.

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