# Laparascopic appendectomy



## R1CPC (Feb 26, 2015)

Doctor performed a laparascopic appendectomy for a ruptured appendix with peritonitis do we code 44970 or 44979?


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## cynthiabrown (Feb 26, 2015)

it is the first code. there is no other lap appy. you have to use that one for rupture or non rupture


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## aocardenas281 (Feb 26, 2015)

*Lap Appy*



E.R.CPC said:


> Doctor performed a laparascopic appendectomy for a ruptured appendix with peritonitis do we code 44970 or 44979?



I would use 44970 with dx code 540.0.


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## cynthiabrown (Feb 27, 2015)

exactly!!!!!


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## surgerycoder (Feb 27, 2015)

I was always told through TCN (The Coding Network) to use the unlisted code and compare it to the open ruptured appy charge, since the work of cleaning out the debris from the rupture entails more work than the lap appy allows for.


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## R1CPC (Feb 27, 2015)

That's why i questioned the code I read somewhere that we should use the unlisted code when dealing with a ruptured appendix with peritonitis/abscess, where I'm having a problem is the operative report I notice the physician says he irrigates the pelvis after removing the appendix does that mean the debridement was done ? If no, is it safe to bill 44970? Does it have to say debridement? If this was an open case would the note have to say debridement in order to bill 44960? I mean isnt that the difference between 44950 and 44960? Help


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## surgerycoder (Feb 27, 2015)

If the Operative report doesn't list any additional/extra work, then yes I would go with the 44970.  Rinsing out the abdomen is done sometimes even with laparoscopic and debridement can not be assumed.  Only when "breaking down" accesses or notations of extra work from the rupture/abscess is when we use the unlisted code.


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## R1CPC (Feb 27, 2015)

Yes I agree on the laparasocpic answer, I just noticed when my physician codes an open case he codes 44960 but the note will only say he irrigated the area Encoder has a note near the picture that says any treatment for peritonitis/abscess would be coded with CPT 44960 so I just wanted to get someone elses opinion should I disregard that note an focus on making sure he says a debridement was done in order to bill 44960 otherwise I default to 44950, right?


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## surgerycoder (Feb 27, 2015)

Since there is a code for open with rupture/abscess, then you can code it that way, if the operative report states that it was ruptured/abscess, regardless if additional work is done.  Just in order to show just cause for using the unlisted procedure instead of the lap code for the non-ruptured/abscess, the operative report has to support the additional work.


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