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Is 49020 bundled with 44143?

  1. Default Is 49020 bundled with 44143?
    Medical Coding Books

    I am trying to figure out if I should bill these two codes together (44143 and 49020). The CCI book stated 49020 is bundled with 44143, However; when I put it in encoder pro, it stated under CCI, that it was a standared medical practice, I took this as you can not bill it seperately, it also said a modifier was allowed, However; when I sent the codes through, it checked out ok with only a 51 on the 49020, I didn't append a 59 on it. If anyone has encoder pro, can you elaborate on what this edit is saying? Also, the following is the question I asked the doctor, this has a little bit more info regarding the report in case that helps:

    The following codes is what I have for the following sx:
    Hartman PX- 44143 DX: 562.11, 682.2
    Drainage pelvic abscess: 49020 DX: 682.2
    Appendectomy: 44955 DX: 541
    I have a question on the drainage pelvic abscess. The CCI edit is telling me that it is bundled( a component of the Hartman PX), and that it is a standard medical practice, which means it can not be charged separately because it is part of the main procedure, However; it seems as if it is giving me the option to bill it as long as the dictation supports separate billing. In order to bill it separate, I would have to append a modifier 59, which will indicate that this procedure was either a different session, a different surgery, different site or organ system, or a separate incision/excision, separate lesion or a separate injury, not ordinarily encountered or performed on the same day by the same individual. In the report, it states the abscess was encountered in the cul de sac adjacent to the sigmoid colon. ( Is the cul de sac distal to the rectum?) I don't see anything that will indicate separate site, incision, session, lesion etc.. Please advise. Thanks!

    Thanks in advance!

  2. #2
    Yes, you can bill all three codes with modifier "51" on each of the second two lines. Best wishes...

  3. Default Reply to Anita
    Great! Thanks for the info!

  4. #4
    Milwaukee WI
    Default Appendectomy for INDICATED purpose
    If the appendix was taken out because the surgeon was "in the neighborhood" and it is common medical practice to remove the appendix in those situations, then NO you cannot code separately for the appendectomy.

    If the appendix was diseased, inflamed, abnormal in appearance, etc ("indicated purpose") then you may use +44955. No modifier needed for this add-on code.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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