General Surgery Coding Alert

Question: During diagnostic laparotomy for abdominal pain, our surgeon found a ruptured left ovarian cyst, as well as an inflamed appendix on the opposite side. May I report both the oopherectomy and the appendectomy separately or is the appendectomy bundled to the oopherectomy? Texas Subscriber Answer: Commercial and Medicare payers will frequently bundle appendectomy to other, same-session abdominal procedures. In this case, however, you can report the appendectomy separately. Why? The appendectomy meets two requirements: 1. There is a documented problem with the appendix. 2. Other same-session procedures do not relate directly to the right colon. Therefore, you would report the left oophorectomy (which occurs in an area separate from the right colon) using 58940 (Oophorectomy, partial or total, unilateral or bilateral) and the appendectomy using add-on code +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]). Remember to list a separate dx. for the appendectomy: Be sure to check the pathology report for the appropriate diagnosis to link to 44955. This is especially important, as the code's describer specifies "when done for indicated purpose-" In most cases, you-ll be citing an appendicitis diagnosis (540-543, Appendicitis, as appropriate) for 44955. Even if the pathology report returns negative for appendicitis, you can still report 44955 with solid documentation explaining that the appendix appeared diseased. In such a case, you-d revert to signs and symptoms or an "other diseases of the appendix" diagnosis.