2 requirements open the door to adding on 44950-44970. There are circumstances when you can -- and should -- separately report appendectomy procedures. Here's how to capture added pay without unbundling. 'Healthy' Removal = No Pay Medicare and most other payers will not pay separately for the removal of a healthy appendix. Reasoning: Example: To avoid paying for removal of healthy appendixes, many payers will expect you to provide proof (such as an op report) that an appendectomy your surgeon performed during the same session as another procedure was medically necessary. Dx Supports Separate Appendectomy Payment If you overlook +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]), you're costing your practice $78.99 (2.19 relative value units [RVUs] times the 2009 conversion factor of $36.0666). You can separately report an appendectomy if the procedure meets two requirements: 1. Your surgeon clearly documented a problem with the appendix 2. 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'll turn to +44955. You will report +44955 in addition to the primary procedure performed. Key: How it works: Scenario: No Specific Dx? Don't Give Up If your 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, use that information to assign the primary diagnosis. "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. Waiting for the pathology report to come back is good practice, Garcia says. Drs. West and Mayo often perform lap appendectomies with lap cholecystectomies. Garcia always waits for the pathology report to decide whether to separately report the appendectomy. Alternative: Watch for +44955 Exceptions Code +44955 is not your only choice for appendectomy. Depending on the circumstances, you may select from three additional codes: • 44950 (Appendectomy). Report 44950 when the appendectomy is the only procedure your surgeon performs during the session. Not reporting 44950 will cost you $579.59 (16.07 RVUs times the 2009 conversion factor of $36.0666). • 44960 (... for ruptured appendix with abscess or generalized peritonitis). Overlooking 44960 means you're forfeiting $778.68 (21.59 RVUs times $36.0666). • 44970 (Laparoscopy, surgical, appendectomy). If your surgeon removes only the appendix laparoscopically, you instead should select 44970, Liddle says. Reporting 44970 will bring you an additional $532.34 (14.76 RVUs times the 2009 conversion factor of $36.0666). You will report 44950/44970 only if the patient's appendix has not burst, Garcia warns. "I won't use the codes that specifically identify a rupture with abscess or peritonitis unless the physician states it, or the path shows that that's what the final diagnosis is," Yomes agrees. On the other hand, if your surgeon removes a ruptured appendix, you would report 44960.