Question: Our surgeon performed a lap chole and, while there, directed the laparoscope-into the right lower abdomen and visualized the appendix. The tip of the appendix was found to be firmer than would be completely normal. He decided to remove the appendix also. Should I charge for lap chole (47562) and appendectomy (44950)? Or should I code 47562 and 44955 for the appendectomy?
New York Subscriber
Answer: Although Medicare and other payers won’t reimburse for the removal of a healthy appendix, you can consider an appendectomy as separate if:
• there is a documented problem with the appendix, and
• other procedures during the same session do not relate directly to the right colon.
You should apply a separate diagnosis to prove to the payer that an appendectomy is medically necessary. If you cannot supply such a separate diagnosis, chances are that the removal isn’t required because of immediate health concerns. If the surgeon doesn’t have a specific diagnosis before opening the patient, you should report the applicable signs and symptoms. If the pathology report shows disease, provide that information as your primary diagnosis.
Bottom line: Unless the appendix appears abnormal (with scarring and/or old inflammatory changes, for example), the removal is incidental to the surgery, and you should not report the appendectomy separately.
When an appendectomy occurs during the same session as another procedure, as in the case you cite, you should report +44955 (Appendectomy; when done for indicated purpose at time of other major procedure [not as separate procedure] [list separately in addition to code for primary procedure]) in addition to the primary procedure (here, the laparoscopic cholecystectomy, 47562, Laparoscopy, surgical; cholecystectomy).
CPT uses the phrase "indicated purpose" in 44955’s descriptor. Again, this means that there must be a separate, medically necessary diagnosis or signs and symptoms to justify the appendectomy. You should note also that 44955 garners no additional payment under APCs.
If the surgeon removes only the appendix using the laparoscope (instead of an "open" approach), you would instead select 44970 (Laparoscopy, surgical, appendectomy: APC 00131). For an "open" appendectomy only, 44950 (Appendectomy) is appropriate, although this is a status indicator "C" code with no associated APC payment.
