Wiki Appendectomy at time of Hysterectomy, Excision of Endometriosis (all via Laparoscope)

[tloeb]

When a provider clearly documents an indication for an appendectomy during a hysterectomy & endo excision (all performed Laparoscopically) as a reason clinically to excise but the pathology has benign findings is it still ok to bill for the appendectomy performed for an indicated purpose?

OP Report:
Appendectomy was then performed due to the turgid and firm nature of the appendix, early or chronic appendicitis was suspected.
The mesoappendix was dissected down to the base and the appendiceal artery was cauterized and transected. Using 0 Vicryl Endoloops, the appendix was tied off at the base using 2 Endoloops and one was placed that was removed with the specimen. The appendix was then transected free and placed in an Endo Catch bag for retrieval. The appendiceal stump was gently cauterized and was noted to be hemostatic. Copious irrigation was performed at the appendix site as well as throughout the pelvis.

Path:
3. Appendix, appendectomy:
- Benign appendix.

Code selection would be:
58571
58662
44979 (custom code to compare to 44955)

Also, if appropriate to bill and because the pathology is benign I am stuggling with the best DX to use, K38.9?

Thank you!

 

[Cmama12]

Hi, for my two cents, as long as there was a suspected problem, regardless of final path, I would say it was indicated and billable. Agree with your codes.

 

[csperoni]

I agree it is billable as there was an indication. I use 44970 for all laparoscopic appendectomies as there is not a separate code for laparoscopic add on appendectomy.

 

[tloeb]

I agree it is billable as there was an indication. I use 44970 for all laparoscopic appendectomies as there is not a separate code for laparoscopic add on appendectomy.

Thank you, I am curious why you would use 44970 rather than the unlisted Laparoscopy Procedure for appendix- 44979 and compare to 44955 which is for an 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)? @csperoni

 

[Cmama12]

Thank you, I am curious why you would use 44970 rather than the unlisted Laparoscopy Procedure for appendix- 44979 and compare to 44955 which is for an 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)? @csperoni

We do have one

 

[tloeb]

We do have one View attachment 7459

44955 is the Open Procedure for Appendectomy perfomed for an Indicated purpose at the time of another procedure not when it is performed Laparoscopically which is why I suggested using the unlisted code 44979 and compare it to 44955.

 

[Cmama12]

44955 is the Open Procedure for Appendectomy perfomed for an Indicated purpose at the time of another procedure not when it is performed Laparoscopically which is why I suggested using the unlisted code 44979 and compare it to 44955.

Right, this is an unlisted code using 44955 as a comparable, hence the title Lap Appendectomy for Indicated Purpose at Time of Other Procedure.

 

[csperoni]

Thank you, I am curious why you would use 44970 rather than the unlisted Laparoscopy Procedure for appendix- 44979 and compare to 44955 which is for an 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)? @csperoni

I use unlisted only when there is no reasonable alternative. To me, since there is no other code specifying laparoscopic appendectomy at time of another surgery, 44970 is reasonable. There is nothing about the description of 44970 which makes it inappropriate. Most codes do not have a different code for when it is performed at the time of another surgery. If I did a laparoscopic lymph node sampling during a hysterectomy, I wouldn't use unlisted, since there is a code for laparoscopic lymph node sampling. I use the same logic here.
If a new code were to come about for this scenario, I would certainly use that instead.

 

[tloeb]

I use unlisted only when there is no reasonable alternative. To me, since there is no other code specifying laparoscopic appendectomy at time of another surgery, 44970 is reasonable. There is nothing about the description of 44970 which makes it inappropriate. Most codes do not have a different code for when it is performed at the time of another surgery. If I did a laparoscopic lymph node sampling during a hysterectomy, I wouldn't use unlisted, since there is a code for laparoscopic lymph node sampling. I use the same logic here.
If a new code were to come about for this scenario, I would certainly use that instead.

Thank you for your response. That is an interesting and likable viewpoint. I had been using 44970 until I used an outside Gyn Onc coder once when I was overloaded and their response was to use the unlisted code as there rationale was that because there is an open code we would need to compare. I will review with my team to make sure I am inline with our other coders at our health system.