# incidental px



## Trendale (Jul 22, 2009)

Hello,
Can somone please help me to determine the correct code on the following report ( I believe the code is 43771 and I'm not sure if I should code the incidental appendectomy and if not, should I put a 22 on the main px? :

Name of procedure: Diagnostic Laparoscopy/ Repair gastric band slippage/ incidental appendectomy

DX: Gastric outlet obstruction and early acute appendicitis

Gross op findings: There were a lot of adhesions found in the area of the gastric band causing a capsule to form around the band and these adhesions were causing a gastric outlet obstruction. Tkedown of thes adhesions and mobilization of the band with stitching relived the obstruction. In addition, the patient had a markedly thickened appendix, primarily at the tip, consistent with a CAT scan that was obtained about 48 hours ago that showed a possible early acute appendicits.

Description of procedure: Under direct laparoscopic vision, we placed a 5mm port about 10cm from the xiphoid in the mid abdomen. We placed a 12mm port in the right upper quandrant, mid subcostal midclavicular line. The Nathanson retractor was now placed through a subxyphoid incision. We now used cautery to take some of the adhesions. immediately, we noticed a gastric outlet obstruction. We began taking down adhesions around it and the capsule that had formed around the band. as we were doing this, we came across the bridge of tissue that was bridging over the band. We were not sure wheteher this was just tissue versus stomach and then we used a load on the Endo-GIA 2.5. We went acrooss it, closed and fired. Once we had done this, the bowel was pretty much mobilized. we were now able to open the band and bring it back up to the area of the EG junction. Three gastrogastric stiches of 0 silk were used to secure the band in place. Once we were done, the liver retractor was removed. We now concentrated and looking at the gallbladder, which looked within normal limits, we then looked at the appendix, which seemed to be very thickened, especially at the tip. We therefore proceeded with an incidental appendectomy.


Thanks!


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## FTessaBartels (Jul 22, 2009)

*NOT "incidental"*

An "incidental" appendectomy is one that is done WITHOUT a specific indication. You had a specific indication in this case...  "early acute appendicitis."

I would code +44955 - Appendectomy, when done for *indicated purpose *at time of other major procedure...

I would also try to educate the physician not to use the "incidental" label when there is a legitimate indication for the procedure. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## Trendale (Jul 23, 2009)

*reply*

Ok, sounds good!

But I am a little confused about the code for appendectomy 44955, wouldn't this be for open? In the report it appears he is still using the scope, did not see incision documentation, I thought 44970-51. What you think?


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## mjewett (Jul 24, 2009)

Letisha,
I thought the same about code 44955+, but last year I attended a General Surgery Coding conference and they instructed us that code 44955 can be for open or laparoscopic.


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## Trendale (Jul 24, 2009)

*Reply-MJEWETT*

Hi,
That is interesting. The CDR as well as the coding compainion says this code can be appiled with any other major PX in which an INCISION has ben made. So my thoughts was that this pertains to an open not scope. Do you have any helpful supporting documentation or links you can send me? Thanks!


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