# open appendectomy



## BABS37 (Feb 13, 2012)

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???


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## kathyshelton (Feb 13, 2012)

Look at 49520 or 49521 and 44955


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## LindaEV (Feb 13, 2012)

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/repair...in 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.


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## BABS37 (Feb 13, 2012)

Ok thank you!


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## BABS37 (Feb 13, 2012)

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.


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## colorectal surgeon (Feb 15, 2012)

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


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