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Re: Table of Risk and Appendicitis

  1. Default Re: Table of Risk and Appendicitis
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    Our hospital has a special program where they bill for the surgeon for those who did not have insurance and the surgeon is reimbursed under this special program.

    They do not necessarily consider a pt who presents to the ER with an appendicitis to be under the emergency major surgery category on the Table of Risk. They are also looking for one or more chronic illnesses with severe exacerbattion. In my mind, I had always thought that an appendicitis would be a condition that would be considered an emergency surgery because it would be life threatening if it was not treated upon presentation. The hospital tends to bill a 99222 rather than a 99223 and these are in the cases where the doctor has met all of the other comprehensive categories. If this is the case, then I would assume that only people that were bleeding severely would be considered an emergency major surgery or someone that was septic, or had severe vascular insufficiency. I don't understand the rationale.

    How do other codes an appendicitis?



  2. #2
    I agree with you. On the Risk table under High, it states, 'Acute or chronic illnesses or injuries that may pose a threat to life or bodily function e.g., ...peritonitis,... '

    If peritonitis is on the list, appendicitis should be included too.

    Hope this helps. Good luck.

  3. #3
    Milwaukee WI
    Default Emergency Major Surgery
    Appendectomies are NOT scheduled, elective surgeries. They are emergency major surgeries and, as such, are classifed as HIGH on the table of risk.

    However, you still need either 4 problems points or 4 data points to achieve the high MDM needed for 99223. Could this be the problem with your physician's documentation?

    Remember risk alone does not qualify for high MDM.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  4. Default
    Thanks for the answer. Sometimes it is unclear to me when the surgery itself is considered an additional workup, especially in an appendicitis. The dx on an appy is not actually always confirmed until the pathology is returned. Would you not consider the surgery diagnostic in many cases and be able to give 4 points for the workup. Often surgical biopsies determine the dx. Do you count only scans, tests, or x-rays in this category.



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