# Laproscopic cholecystectomy w/ appendectomy



## mrolf (Aug 20, 2010)

How would you bill this scenario: Patient had a laproscopic cholecystectomy  and  they also did an incidental laproscopic appendectomy using the same trocar site. THis was not decided prior to the laproscopic  cholecystectomy. Would you use CPT code 47562 and 44970. Any modifiers??.  Please advise.  Thanks.


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## rmickalich (Aug 20, 2010)

It is bundled in the laprascopic cholecystectomy CPT.


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## preserene (Aug 20, 2010)

That is very much correct for open conventional; and the incidental appendectomy also goes with the open intraabdominal surgical procedure.
 Does it apply to lap too?
If it is applicable so for a laproscopic incidental appendectomy , then the same holds good with the code +44955 (which is for open procedure) again but could be used for lap too. Is that right? 
 And it also says,"if necessary to report, add modifier52"
So, along with 47562, 44970-52 also another way of reporting. Is that right?

Or it is not totally applicable for lap just as it does for open procedure?
Why this doubt is because I didnot notice at the lap cholesytectomy/appendectomy such bundling. 

Or is it a common  rule/ guideline for irrespective of open or Lap, when major abdominal surgeries done that incidental appendectomy is bundled (just as we have the BSO bundled with hysterectomy)?
kindly clear my doubt please.


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## mitchellde (Aug 20, 2010)

If it is an incidental appy then there is no medical necessity for it, or you can say there is no therapeutic value to the patient. Also there is no prior approval for the procedure, without clear medical necessity present you have to ask yourself how you are going to try to appeal this for payment?  So I tend to believe an incidental appy is inclusive to the definitive procedure regardless of route.


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## preserene (Aug 20, 2010)

That is right and very much understandable. But then, the cpt manual codes are not specifying that under code description, so much so  that when it comes to CPC exam point of view, can we apply this same as you said?
Some times as regards to some instances, I wonder that the exam point of view( for getting thro'), do not apply in the practical coding? Is that right?
Thank you very much.


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## mitchellde (Aug 20, 2010)

The CPT book states "If necessary" then report with the 52 modifier.  For documentation to state incidental then we can infer that necessity was not present.  I would think the CPC exam would be consistent with this.


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## preserene (Aug 21, 2010)

Thank you I got it.  But the  snag is in "necessary" criteria. Does it mean that there shoud be a medical necessity to do it like inflammed appendix/adhesion; not as a prophylactic, bieng a vestigeal organ ?


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## mitchellde (Aug 21, 2010)

That has always been my understanding.


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