General Surgery Coding Alert
Adhere To This Appendectomy Advice
Question: Our surgeon began a laparoscopic appendectomy for a patient with signs of an infected appendix, including sudden pain around the navel that shifted to the right lower abdominal quadrant, along with nausea. During the operation, the surgeon discovered a ruptured appendix accompanied by inflammation within the abdominal cavity. Consequently, the surgeon transitioned to an open procedure. The surgeon also performed debridement and lavage to remove infected tissue and fluid but made no mention of perforation or abscess. How should we code the service? AAPC Form Participant Answer: The codes for the two procedures — open or laparoscopic appendectomy — are as follows: Note: When the surgeon converts from a laparoscopic to an open procedure, you should report only the completed and more complex (open) procedure. That means you should report the service using 44960, and not report 44970 at all. The appendectomy for a ruptured appendix includes debridement and lavage, so you should not separately report that service using a code such as 49084 (Peritoneal lavage, including imaging guidance, when performed). Remember: To support the procedure and accurately describe the patient’s situation, you should code first the ruptured appendix using K35.200 (Acute appendicitis with generalized peritonitis, without perforation or abscess). You should list a secondary diagnosis of Z53.31 (Laparoscopic surgical procedure converted to open procedure).
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