# Lap appendectomy converted to open



## MnTwins29 (Jan 15, 2010)

I am reading the results of an audit done on our hospitalists.  For the surgeon, a case reviewed was a lap appendectomy converted to open, in which the codes assigned were 44905 and 44180.  V64.41 was also coded correctly.  The auditor said that 44180 could not be coded, since this is included in 44905.  I contend this is not true since 44905 is open.  Who is correct?


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## FTessaBartels (Jan 15, 2010)

*Separate procedure*

First, I assume you mean that you coded 449*50* (open appendectomy) and 44180.

44180 is laparoscopic lysis of adhesions and is considered a "separate procedure." This means it cannot be coded unless it it truly separate from other procedures performed in the same operative session. 

Your auditor is correct.   

However, if you have documentation of considerable effort in performing the lysis (I'm talking an additional hour or more over and above the time required for the primary procedure) you could append a -22 modifier to your main code.

Of course, in either case, you will need to send the operative report with your appeal. 

Hope that helps. 

F Tessa Bartels, CPC, CEMC


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## MnTwins29 (Jan 19, 2010)

*No extra time*

This didn't take long or had any unusual circumstances, hence modifer -22 would not be considered.  What I believed is that you could use -59 on the lysis since this was a laparoscopic procedure and then bill for 44950 (sorry for the typo!), the open procedure.  Another grey area for -59, the "separate procedure" conundrum.  

I certainly understand the lysis being bundled if done in the same manner as the appendectomy, but just thought this might qualify, since they are "different."


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