So you think appendectomy always comes bundled with other procedures. If so, you need to think again. You can report appendectomy separately depending on what the situation demands. If you miss your appendectomy codes, you could be losing your deserved payments.
Many people are of the false notion that skipping appendectomy codes has no bearing. Whereas the fact is if you fail to report 44955 when the situation demands, you would be costing your practice $83.58 (2.46 relative value unit times the 2011 conversion factor of $33.9764).
Familiarize yourself with these two requirements for separate appendectomy:
a) Your surgeon clearly documented a problem with the appendix
b) Other procedures during the same session do not relate directly to the right colon. When your gastroenterologist carries out a medically necessary appendectomy at the same time as another procedure, you would use +44955 (reported in addition to the primary procedure performed).
Using 44955 follows that you code a diagnosis to prove that the procedure was medically necessary.
Clue: If you cannot find an appropriate diagnosis code to support 44955, there are chances that the removal wasn't required because of immediate health concerns, and you shouldn't be separately reporting the appendectomy after all. Your answer to supplying a separate ICD-9 for 44955 lies in the CPT's descriptor, which includes the phrase “indicated purpose. This means that there must be a separate, medically necessary diagnosis or signs and symptoms to justify the appendectomy.
Here's an example: The patient has a gallbladder problem, and while carrying out the gallbladder removal, the surgeon finds acute appendicitis as well; as such he carries out an appendectomy. In this instance, you should use 44955 as well as the cholecystectomy. (for instance 47562, Laparoscopy, surgical; cholecystectomy). Also, you should bill 540.9 (Acute appendicitis without mention of peritonitis) to support your claim.
Physician's notes suggest you should scoop up info from path report
Also, you can take a look at the applicable signs and symptoms or the pathology report to verify your diagnosis code(s). See to it that your codes are supported by both your physician's documentation and your path report.
Even if the pathology report turns out to be negative for appendicitis, you can still report 44955 as long as the physician's documentation clearly states the reason he is removing the appendix.
Many people are of the false notion that skipping appendectomy codes has no bearing. Whereas the fact is if you fail to report 44955 when the situation demands, you would be costing your practice $83.58 (2.46 relative value unit times the 2011 conversion factor of $33.9764).
Familiarize yourself with these two requirements for separate appendectomy:
a) Your surgeon clearly documented a problem with the appendix
b) Other procedures during the same session do not relate directly to the right colon. When your gastroenterologist carries out a medically necessary appendectomy at the same time as another procedure, you would use +44955 (reported in addition to the primary procedure performed).
Using 44955 follows that you code a diagnosis to prove that the procedure was medically necessary.
Clue: If you cannot find an appropriate diagnosis code to support 44955, there are chances that the removal wasn't required because of immediate health concerns, and you shouldn't be separately reporting the appendectomy after all. Your answer to supplying a separate ICD-9 for 44955 lies in the CPT's descriptor, which includes the phrase “indicated purpose. This means that there must be a separate, medically necessary diagnosis or signs and symptoms to justify the appendectomy.
Here's an example: The patient has a gallbladder problem, and while carrying out the gallbladder removal, the surgeon finds acute appendicitis as well; as such he carries out an appendectomy. In this instance, you should use 44955 as well as the cholecystectomy. (for instance 47562, Laparoscopy, surgical; cholecystectomy). Also, you should bill 540.9 (Acute appendicitis without mention of peritonitis) to support your claim.
Physician's notes suggest you should scoop up info from path report
Also, you can take a look at the applicable signs and symptoms or the pathology report to verify your diagnosis code(s). See to it that your codes are supported by both your physician's documentation and your path report.
Even if the pathology report turns out to be negative for appendicitis, you can still report 44955 as long as the physician's documentation clearly states the reason he is removing the appendix.
