General Surgery Coding Alert

Question: While performing gastroenterostomy, the surgeon also removed the patient's appendix. May we report this procedure separately?

Michigan Subscriber

Answer: Surgeons often remove the appendix during bariatric surgery (for example, 43846, Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb [less than 100 cm] Roux-en-Y gastroenterostomy). You may report removal of the appendix separately using 44950 (Appendectomy) - as long as the surgeon encounters evidence of an inflamed appendix (in other words, medical necessity must support the removal of the appendix).
 
Surgeons may remove the appendix as a preventive measure during bariatric surgery, but unless the appendix appears abnormal (with scarring and/or old inflammatory changes, for example), the removal is incidental to the surgery, and you should not report 44950 separately.
 
The same guidelines hold if the surgeon performs cholecystectomy - which is also common during bariatric surgery. If the patient has cholelithiasis (gallstones) or cholecystitis (an inflamed gallbladder), you may legitimately report a separate cholecystectomy (47600).
 
If the surgeon performs cholecystectomy as an incidental, common component of bariatric surgery without any evidence of cholelithiasis, you cannot report 47600 in addition to 43846 or 43847.
 
You may wish to check the pathology report for any evidence of disease in the appendix or gallbladder if the operative note does not make clear whether the surgeon performed the removal for prevention or treatment. Documented evidence of inflammatory changes or stones will allow you to bill for the removal with confidence.