General Surgery Coding Alert

When reporting laparoscopic procedures, you should never use a code that describes an open approach. Unfortunately, while answering a recent reader question, the editors of General Surgery Coding Alert made just this mistake.

The question ("Appendectomy Can Be Separate With Proof of Disease," Vol. 10, No. 2, page 15) stated, "Our surgeon performed a laparoscopic cholecystectomy and, while there, directed the laparoscope-into the right lower abdomen and - found the tip of the appendix to be firmer than - normal. He decided to remove the appendix also." The question went on to ask for the proper coding.

The answer advised, "When an appendectomy occurs during the same session as another procedure, 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." Although this advice is correct, it applies only to open procedures. Because the surgeon performed a laparoscopic appendectomy (in addition to the lap chole, 47562) in this case, 44955 is incorrect.

Rather, as the answer later notes, you should report a laparoscopic appendectomy using 44970 (Laparoscopy, surgical, appendectomy). Just as when you are reporting 44955, however, you should cite a medically necessary diagnosis, or signs and symptoms, to justify reporting 44970, whether the laparoscopic appendectomy occurs alone or at the same time as another procedure.

Finally, you should select 44950 (Appendectomy) when open appendectomy is the only procedure the surgeon performs during the session.

Special thanks to reader Bobbi M. Bohon, CPC, of Seven Hills Surgical in Lynchburg, Va., for catching the error and providing the correct information.