Gastroenterology Coding Alert

Find out what circumstances justify which appendectomy code.

If you think appendectomy always comes bundled with other procedures, think again. You can separately report appendectomy depending on what the situation calls for. Missing your appendectomy codes could cost you about $84- $860 in payout. Bust these 3 myths to arm yourself against misinformation and get that deserved reimbursement.

Myth 1: Physicians Removing a 'Healthy' Appendix Warrant Payment

Reality: If your surgeon performs removal of a healthy appendix, most payers will not pay for the service separately. You will have to go through some tiring paperwork (i.e., op report) to prove that an appendectomy your surgeon performed during the same session as another procedure was medically necessary.

Appendectomies during the course of a more extensive abdominal procedure are fairly common. Usually, the surgeon performs the procedure as a precautionary measure since he already has the patient's abdomen open and removing the appendix eliminates a potential health problem down the road. For instance, a surgeon may remove a patient's appendix during bariatric surgery (43846, Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb [150 cm or less] Roux-en-Y gastroenterostomy]). You should never report the appendectomy separately unless the surgeon indicates that the appendix was abnormal.

Myth 2: Skipping Appendectomy Codes Has No Bearing

Reality: If you failed to 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]) when the situation merits it, you would be costing your practice $83.58 (2.46 RVUs times the 2011 conversion factor of $33.9764).

You should familiarize yourself with these two requirements for separate appendectomy:

• Your surgeon clearly documented a problem with the appendix
• Other procedures during the same session do not relate directly to the right colon. When your gastroenterologist performs a medically necessary appendectomy at the same time as another procedure, you would use +44955 (reported in addition to the primary procedure performed).

Reporting 44955 follows that you code a diagnosis to prove that the procedure was medically necessary, according to Karla D. Garcia, CPC, coder for Drs. West and Mayo in Paducah, Ky.

Hint: If you can't find a fitting diagnosis code to support 44955, chances are that the removal wasn't required because of immediate health concerns, and you shouldn't be separately reporting the appendectomy after all. Your clue to supplying a separate ICD-9 for 44955 lies in the CPT's descriptor, which includes the phrase "indicated purpose." This means that there must be a separate, medically necessary diagnosis or signs and symptoms to justify the appendectomy.

Example: The patient has a gallbladder problem, and while performing the gallbladder removal, the surgeon finds acute appendicitis as well, so he performs an appendectomy. In this case, you should report 44955 as well as the cholecystectomy (for example, 47562, Laparoscopy, surgical; cholecystectomy). You should also bill 540.9 (Acute appendicitis without mention of peritonitis) to support your 44955 claim.

Scoop Up Info from Path Report, Physician's Notes

You can also look at the applicable signs and symptoms or the pathology report to verify your diagnosis code(s). "Always make sure that your codes are supported by both your physician's documentation and your path report," cautions Sundae Yomes, CPC, trauma services coder at HCA Physician Services in Las Vegas.

Suppose the pathology report returns negative for appendicitis, you can still report 44955 as long as the physician's documentation clearly states the reason he is removing the appendix. The fact that the pathology didn't come back with a disease diagnosis doesn't automatically negate that the surgeon performed the removal for a specified reason.

Myth 3: You're Stuck With 44955

In fact, you have three more codes to choose from when coding appendectomy:

• 44950 (Appendectomy). Report 44950 when the appendectomy is the only procedure your surgeon performs during the session. Not reporting 44950 will cost you $631.62 (18.59 RVUs times the 2011 conversion factor of $33.9764).
• 44960 (... for ruptured appendix with abscess or generalized peritonitis). Overlooking 44960 means you're forfeiting $858.24 (25.26 RVUs times $33.9764).
• 44970 (Laparoscopy, surgical, appendectomy). If your surgeon removes only the appendix laparoscopically, you instead should select 44970. Reporting 44970 will bring you an additional $586.09 (17.25 RVUs times the 2009 conversion factor of $33.9764).

Remember: You should report 44950 and 44970 only if the patient's appendix has not burst. On the other hand, if your surgeon removes a ruptured appendix, you would report 44960.