Results 1 to 5 of 5

separate procedures

  1. Question separate procedures
    Medical Coding Books
    Looking for some advice on coding a lap appy and also an epiplocectomy. Dr. did the procedure due to inflammatory changes and necrotic appendix epiploica. I am not as to whether i am able to bill for both the appendectomy and the epiplocectomy when i look at the coding guidelines it states that unless there is separate diagnosis for the appendectomy that i cant bill for it, however, my doctor feels that the diagnosis of the necrotic appedix epiploica and normal appearing appendix with surrounding inflammatory changes is sufficient enough to substantiate the coding of both. I appreciate any advice regarding this.

  2. #2
    Johnson City
    I usually bill code 44205 when the Doctor does a cecectomy, this code includes removal of the appendix too. So it should cover everything.
    Melissa Jewett, CPC

  3. #3
    what if the procedure was performed laparoscopically?

    The patient was placed supine and underwent general endotracheal anesthesia. The abdomen was prepped and draped in normal sterile fashion. An infraumbilical incision was made. The fascia was incised. The camera trocar was inserted and pneuomoperitoneum was created to a pressure of 15. A 5-mm suprapubic and 12-mm left lower quadrant trocars were placed under direct vision. We then generously mobilized the terminal ileum, cecum and appendix by incising lateral peritoneal attachments. This was dissected well off the retroperiotoneum. The appendix was elevated. The mesoappendix was taken down with Ligasure. A window was created through the mesoappendix adjacent to the base of the cecum. We completed the dissection of the mesoappendix with the Ligasure. We also dissected some surrounding mesentery of the cecum, completely exposing the cecum. The ileocecal valve was also identified or at least the junction of the ileum with the cecum. We had adequate length on the cecum to transect this for removal of the base of the cecum and the appendix. We obtained an endoscopic stapler with 3.5 mm staples. This was placed across the cecum and fired. This adequately transected and subsequently closed the cecal stump. The cecum and appendix were removed with the EndoCatch. It was opened on the back table and confirmed a polyp right at the base of the appendix completely excised.
    The RLQ was irrigated. The fluid was evacuated. Hemostasis was assured. The staple line was visualized and intact. The trocars were removed. The pneumoperitoneum was released. The fascia at the umbilical site was closed with 0 Vicryl. The wounds were irrigated and closed with Monocryl suture. Steri-strips and sterile dressings were applied. The patient was awaken and returned to the recovery room in stable condition. Tolerated the procedure well without evidence of complications. All counts were correct.

    All of the colectomy codes include anastomosis - which to me it doesnt seem like he did. I was looking at 44110 since the dx was colon polyps but this is an open code. Does anyone have any suggestions?
    Mary Beth Gord, CPC

  4. Default
    I was wondering the same about the anastomosis...all the cloectomy codes include one.

  5. Default
    After reviewing your op note, it looks more like a laparascopic appendectomy with a small portion at the base of the cecum taken with it. The polyp was located at in teh appendix and the inflammatory cahnges were more about teh appendix. I believe the MD was taking the base of the cecum just to make sure he got all of the inflammatory if this is the case, I would bill lap appy, 44970. Add 22 if you could really prove taking the cecum was really alot of extra work and risk.

    The 44140-44160 (Lap 44202-44213) are really resection (not transection codes). Most either include an anastomosis and/or the creation of a stoma. 44110 is good for transections of lesions from small and/or large intestines; however, in this op note he states the lesion is at teh base of the appendix, not cecum. He is only taking the cecum becasue he does not want to leave any inflammatory process behind. Per cross coder, you cannot bill 44110 for cecal inflammation. 44110 only allows for neoplasms, endometriosis, and postoperative adhesions.

Similar Threads

  1. ASC facility billing 2 separate dr. 2 separate procedures
    By seslinger in forum Outpatient Facilities
    Replies: 1
    Last Post: 07-07-2015, 06:36 PM
  2. Separate Procedures
    By nyyankees in forum Gastroenterology
    Replies: 2
    Last Post: 04-03-2013, 01:25 PM
  3. ED Separate procedures
    By in forum Emergency Department
    Replies: 2
    Last Post: 07-10-2012, 04:09 PM
  4. Two separate procedures on same date
    By JulieK in forum Anesthesia
    Replies: 2
    Last Post: 10-17-2011, 06:19 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.