General Surgery Coding Alert

Question: We are not supposed to bill for an incidental appendectomy, so how would I indicate that the surgeon removed the appendix if I need to account for complications that arise from the appendectomy? Can I bill for the appendectomy CPT code but with $0.00?

North Carolina Subscriber

Answer: According to CPT, if you wish to report an incidental appendectomy you should use code 44950 (Appendectomy) with modifier 52 (Reduced services). You can assign an appropriate fee based on your own judgment.

You should be aware, however, that you do not establish medical necessity using CPT codes. That is the role of ICD-9 codes. If you want to identify a complication of surgery, you should use codes from categories 996 -- 998 (Complications of surgical and medical care, not elsewhere classified). You can also use V codes to describe situations, such as V45.79 (Other acquired absence of organ) if you need to indicate that the appendix is absent.

Look at it this way: If another surgeon had removed the patient's appendix and then your physician ended up dealing with a complication, you would not try to bill the appendectomy. You would bill only for the work associated with care of the complication.

Best bet: Skip the CPT code for the appendectomy and just use the ICD-9 codes to describe the situation.