General Surgery Coding Alert
Document Medical Necessity for Appendectomy
Question: Our surgeon performed a Roux-en-Y bariatric surgery procedure. During the procedure the surgeon noted an inflamed appendix with scarring and also performed an appendectomy. How should we code this? Utah Subscriber Answer: You don’t mention if the procedure is open or laparoscopic. Assuming this is an open procedure, report the Roux-en-Y as 43846 (Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomy). If the short limb is greater than 150 cm, you should instead report 43847 (… with small intestine reconstruction to limit absorption). Because the surgeon notes abnormality in the appendix, you should separately report that procedure as +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)). Documentation: To demonstrate medical necessity for the appendectomy, you need to list an appropriate diagnosis code based on the op note, such as K36 (Other appendicitis). Surgeons often incidentally remove the appendix during bariatric surgery, which is not separately billable. You should use +44955 only with evidence of symptoms or pathology that indicate the need for the procedure.
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