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open appendectomy

  1. #1
    Default open appendectomy
    Medical Coding Books
    If my physician goes in to do an open appendectomy for acute appendicitis but thinking it's trapped in the hernia sac- but then realizes its not appendicitis- so he removes the appendix anyway and does a reducible repair of a recurrent ingunal hernia, then would I code the open appendectomy as 44955 with the hernia???

    Brooke Bierman, CPC, CPB
    Coding & Billing Manager
    2014 President AAPC Des Moines Chapter

  2. #2
    Look at 49520 or 49521 and 44955

  3. #3
    Kansas City, MO
    He was "thinking" it was trapped? Or it was trapped?

    If it was trapped, you could probably argue for medical neccessity, but may need to appeal if initial claim denies.

    Per the CPT book "the excision/repair of strangulated organs or structures....are reported by using the appropriate code for the excision/ addition to the code for the repair of the strangulated hernia."

    You'll just need the op note to show it was not just incidental, and was medicically necessary.
    Linda Vargas, CPC, CPCO, CPMA, CPC-I, CEMC,CCC, AAPC Fellow
    PMCC Licensed Instructor
    2018 Chapter President, Kansas City, MO

  4. #4
    Ok thank you!

    Brooke Bierman, CPC, CPB
    Coding & Billing Manager
    2014 President AAPC Des Moines Chapter

  5. #5
    Oh his pre-op DX- he said the appendix appeared trapped in the inguinal region.

    The more I read this OP note, the more confused I get . He says he opened the hernia sac, saw the appendix with no appendicitis. He created a window at the base of the mesoappendix at the junction with the cecum and the base of the appendix was divided at the cecum with an endo gia stpler. the mesoappendix was divided with a vascular load on the endo gia. No bleeding was evident at the staple lines and the cecum was reduced back into the abdomen then he went in to do the hernia repair.

    Brooke Bierman, CPC, CPB
    Coding & Billing Manager
    2014 President AAPC Des Moines Chapter

  6. #6
    Sounds like 44955 - appendectomy done for indicated purpose at time of other major operation in addition to the hernia repair.

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