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Billing for incidental appendectomy's

  1. #1
    Dickson, TN
    Smile Billing for incidental appendectomy's
    Medical Coding Books
    Does anyone bill for incidental appendectomies? Example: Patient has a Ladds procedure with an incidental appendectomy. There is no documented diagnosis to support why we performed the appy. So, would you bill a +44955 in addition to the 44055 for the Ladds procedure. Or does the 44955 indicate that we would need a 540.9 inorder to bill it? What if we used a diagnosis for v code for prophylactic organ removal? We have never billed these and it was suggested that we might be missing revenue by not capturing these. Thanks for reading!

  2. Default
    Well I would say you have to have an indicated purpose as to why you took that appendix out. Because per CPT book under 44955 it says when done for indicated purpose at time of other major procedure.
    Also, under 44950 it says Incidental appendectomy during intra-abdominal surgery does not usually warrant a separate identification. If necessary to report add mod 52.
    So you need a documented reason in order to bill for that add on code if done incidentally.

  3. #3
    Dickson, TN
    Thanks! That make's perfect sense when you said it!

  4. #4
    Milwaukee WI
    Default Incidental
    If you are removing the appendix just because you happen to be "in the neighborhood" and it's prophylactic without any indication of disease or problem, then NO you should not code it.

    If you are removing the appendix because you happen to notice a problem - for example, it is inflamed or calcified - then it's not "incidental" but for an "indicated purpose," and you code +44955.

    If you are removing the appendix NOT because there's anything wrong with the appendix, but because the bowel surgery you've just done has rearranged the patient's anatomy, so the appendix is no longer where it would be and would pose a risk to the patient in the future if left alone, you have an "incidental" appendectomy that warrants reporting with a -52 modifier.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 09-25-2009 at 03:15 PM.

  5. Default Incidental
    F Tess,

    Great explanation. I totaly agree with your explanation.


  6. Default
    Has anyone seen a surgeon do an inversion appendectomy at the same time as a Ladd's? I'm not sure how to code for this procedure when it is done at the same time as a Ladd's. My provider describes the inversion appendectomy as when the appendix is litigated and then sutured into the cecum where the tissue dies and eventually is evacuated through normal bowel function.


  7. Default

    Great reply... totally agree with your answer...



  8. #8
    Unhappy Appendectomy Nightmare
    I've never been able to get an appendectomy paid during the same session as another procedure.

    Even though the following code:
    44950 it says Incidental appendectomy during intra-abdominal surgery does not usually warrant a separate identification.

    I'm in Florida and have tried to bill this to multiple insurance carriers when the patient has acute appendicitis in addition to another condition. I've tried appealing this with letters from the MD, Path report and op-note.
    If anyone has successfully gotten these paid on these, please let me know what I need to do to get paid.

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