General Surgery Coding Alert

Question: Our surgeon began a laparoscopic appendectomy for a patient with signs of an infected appendix, including sudden pain around the navel that shifted to right lower abdominal quadrant, along with nausea. During the procedure, the surgeon identified that the appendix had ruptured, with extensive inflammation in the abdominal cavity. The surgeon then converted to an open procedure. The surgeon also performed debridement and lavage to remove infected tissue and fluid but made no mention of perforation or abscess. How should we code the service?

Oregon Subscriber

Answer: The codes for the two procedures — open or laparoscopic appendectomy — are as follows:

• 44960 (Appendectomy; for ruptured appendix with abscess or generalized peritonitis)
• 44970 (Laparoscopy, surgical appendectomy)

Key: When the surgeon converts from a laparoscopic to an open procedure, you should report only the successful (open) procedure. That means you should report the service using 44960, and not report 44970 at all.

The appendectomy for a rupture appendix includes debridement and lavage, so you should not separately report that service using a code such as 49084 (Peritoneal lavage, including imaging guidance, when performed).

Medical necessity: To support the procedure and accurately describe the patient’s situation, you should code first the ruptured appendix using K35.200 (Acute appendicitis with generalized peritonitis, without perforation or abscess). You should list a secondary diagnosis of Z53.31 (Laparoscopic surgical procedure converted to open procedure).