General Surgery Coding Alert

Question: There are different codes for open appendectomy depending on whether the appendix is ruptured or not, but only a single code for laparoscopic appendectomy. This seems incorrect because appendec-tomy of a ruptured appendix is more difficult, takes longer and requires more inpatient post-op care than one that is not ruptured, even when performed laparoscopically. Can I report a laparoscopic appendectomy for a ruptured appendix as 44960?


Michigan Subscriber

Answer: You should definitely not report 44960 (Appendectomy; for ruptured appendix with abscess or generalized peritonitis) for a laparoscopic approach. CPT rules outlined in the manual's introduction specifically state, -do not select a CPT code that merely approximates the service provided.-

In this case, therefore, you should not report a laparoscopic procedure using an -open- code.

Your best choice is to report the laparoscopic appendectomy code (44970, Laparoscopy, surgical, appendectomy) and append modifier 22 (Unusual procedural services) for ruptured appendix. This assumes, however, that the surgeon's op note supports the contention that the procedure was especially difficult or time-consuming. Documentation should note specifically that the appendix was ruptured and include a statement reminding the payer that post-op care can be significantly prolonged in a ruptured vs. nonruptured appendectomy, regardless of the method of surgery (open or lap).

You-ll have to make the documentation available to the payer, and ask for additional compensation commensurate with the additional physician effort.