General Surgery Coding Alert

Question: While performing bariatric surgery (Roux-en-Y), our surgeon also performed an appendectomy. Can we bill separately for the appendix?

North Carolina Subscriber

Answer: No, you should not separately report the appendectomy based on the information you provided. If the surgeon removes the appendix incidental to the bariatric surgery, you should code only for the latter procedure (such as 43846, Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb [150 cm or less] Roux-en-Y gastroenterostomy).

Caveat: If the surgeon documents suspicious findings that prompted the appendectomy, and the pathology report confirms the pathology, you can separately code the appendectomy.

Do this: You should report the separate diagnosis that indicates medical necessity for the appendectomy, such as appendicitis with generalized peritonitis (540.0, Acute appendicitis with generalized peritonitis). Then you can separately bill for the appendectomy by reporting +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 43846.

Caution: If the pathology report returns negative, however, you should not separately report the appendectomy (because there is no diagnosis to support the procedure).