# separate procedures



## hclark (Mar 3, 2010)

Looking for some advice on coding a lap appy and also an epiplocectomy.  Dr. did the procedure due to inflammatory changes and necrotic appendix epiploica.  I am not as to whether i am able to bill for both the appendectomy and the epiplocectomy when i look at the coding guidelines it states that unless there is separate diagnosis for the appendectomy that i cant bill for it, however, my doctor feels that the diagnosis of the necrotic appedix epiploica and normal appearing appendix with surrounding inflammatory changes is sufficient enough to substantiate the coding of both.  I appreciate any advice regarding this.


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## mjewett (Mar 4, 2010)

I usually bill code 44205 when the Doctor does a cecectomy, this code includes removal of the appendix too. So it should cover everything.


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## mgord (Apr 5, 2010)

what if the procedure was performed laparoscopically? 

The patient was placed supine and underwent general endotracheal anesthesia. The abdomen was prepped and draped in normal sterile fashion. An infraumbilical incision was made. The fascia was incised. The camera trocar was inserted and pneuomoperitoneum was created to a pressure of 15. A 5-mm suprapubic and 12-mm left lower quadrant trocars were placed under direct vision. We then generously mobilized the terminal ileum, cecum and appendix by incising lateral peritoneal attachments. This was dissected well off the retroperiotoneum. The appendix was elevated. The mesoappendix was taken down with Ligasure. A window was created through the mesoappendix adjacent to the base of the cecum. We completed the dissection of the mesoappendix with the Ligasure. We also dissected some surrounding mesentery of the cecum, completely exposing the cecum. The ileocecal valve was also identified or at least the junction of the ileum with the cecum. We had adequate length on the cecum to transect this for removal of the base of the cecum and the appendix. We obtained an endoscopic stapler with 3.5 mm staples. This was placed across the cecum and fired. This adequately transected and subsequently closed the cecal stump. The cecum and appendix were removed with the EndoCatch. It was opened on the back table and confirmed a polyp right at the base of the appendix completely excised. 
The RLQ was irrigated. The fluid was evacuated. Hemostasis was assured. The staple line was visualized and intact. The trocars were removed. The pneumoperitoneum was released. The fascia at the umbilical site was closed with 0 Vicryl. The wounds were irrigated and closed with Monocryl suture. Steri-strips and sterile dressings were applied. The patient was awaken and returned to the recovery room in stable condition. Tolerated the procedure well without evidence of complications. All counts were correct. 


All of the colectomy codes include anastomosis - which to me it doesnt seem like he did. I was looking at 44110 since the dx was colon polyps but this is an open code. Does anyone have any suggestions? 
Thanks!!


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## kingkong (Jul 9, 2010)

I was wondering the same about the anastomosis...all the cloectomy codes include one.


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## acbarnes (Jul 15, 2010)

After reviewing your op note, it looks more like a laparascopic appendectomy with a small portion at the base of the cecum taken with it. The polyp was located at in teh appendix and the inflammatory cahnges were more about teh appendix. I believe the MD was taking the base of the cecum just to make sure he got all of the inflammatory process.....so if this is the case, I would bill lap appy, 44970. Add 22 if you could really prove taking the cecum was really alot of extra work and risk. 

The 44140-44160 (Lap 44202-44213) are really resection (not transection codes). Most either include an anastomosis and/or the creation of a stoma. 44110 is good for transections of lesions from small and/or large intestines; however, in this op note he states the lesion is at teh base of the appendix, not cecum. He is only taking the cecum becasue he does not want to leave any inflammatory process behind. Per cross coder, you cannot bill 44110 for cecal inflammation. 44110 only allows for neoplasms, endometriosis, and postoperative adhesions.


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