# Lap Appy w partial cecectomy



## ksb0211 (Mar 1, 2011)

As I was looking through the previous posts, I see that there were differing answers.  Hoping I can get an updated opinion.  

Op Report:

Diagnosis:  Ruptured Appendicitis

Procedure: Laparscopic Appendectomy with partial cecectomy

Description:
...
A 5 mm infraumbilical incision was made, and we entered the abdominal cavity with a Veress needle. Insufflated to 14 mmHg and placed a 5 mm port in the left lower quadrant, a 12 mm port just above the pubis. Developed our exposure about the porta hepatis. I saw that the appendix was at least in part retrocecal. We mobilized the cecum using the harmonic scalpel and it was just adhesed, and it turned out that this perforation was right at the base of the cecum and it afforded us little opportunity to carry out a formal appendectomy. We really needed to take the end of the cecum. We mobilized the appendix and the cecum, took down the mesoappendix with the harmonic scalpel, and then got it set up so that we could come across the base of the cecum with the stapler. We fired two loads of staples across it because it just was not long enough to get across it in one shot, fired it, and then we were able to get the appendix and distal cecum off in one piece where we had a nice, smooth, clean anastomotic site. Placed the appendix in an EndoCatch bag. There was a large __________ which came out as well. We put that in the EndoCatch bag. We then removed it from the patient. We irrigated the operative field with antibiotic-containing solution. There was just some __________ spillage from the perforation of the appendix. Once we had irrigated, we had a dry operative field without any oozing, and we then aspirated all fluid and then closed the pubic wound with figure-of-eight suture of Monocryl followed by a running subcuticular suture of 4-0 Vicryl. ...

Any thoughts would be greatly appreciated.
Thanks.
~Kelly


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## ksb0211 (Mar 7, 2011)

Any takers?  

I was looking at 44205 & 44970

???


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## FTessaBartels (Mar 18, 2011)

*Check your CCI edits*

You should check your CCI edits ... I think you'll find that you can only use one of these codes, not both.

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## mgord (May 16, 2011)

Would the 44205 be appropriate because there was no ileocolostomy?


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## colorectal surgeon (May 17, 2011)

44205 is not appropriate. That's a lap right colectomy with anastomosis. I don't see an appropriate code. I would favor submitting an unlisted code with RVU's similar to an open ruptured appendectomy (44960, 25 RVU)


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