CPT Coding: Appendectomy with Partial Cecectomy


by Gail I. Smith, MA, RHIA, CCS-P

I recently heard from a CPT coder who asked:

“I am having trouble coding an appendectomy converted to open appendectomy with partial cecectomy. I am thinking you would use 44950-22. The 22 modifier captures the partial cecectomy. Am I correct?”

We need to know more about the patient’s story to help support coding decisions. Before we look at possible scenarios, let’s review the code descriptions for an open appendectomy:

Appendectomy Review
CPT Code 44950: Incidental appendectomy. If the normal appendix was removed because the surgeon was already performing another intra-abdominal procedure then no CPT code should be submitted. It gets a little confusing with the additional instruction under code 44950 that states “if necessary” a coding professional may assign this code with modifier 52. What does the “if necessary” mean? It probably means that you will have to submit an operative report that clearly indicates why the appendix was removed during the other intra-abdominal surgery. Why CPT left that door open, I have no idea. Payer specific guidelines would have to be referenced to determine if reimbursement for that code is an option. I believe it is a dead end. There was a time that incidental appendectomies were common, but there are varying opinions in the medical community about removing a normal appendix.

CPT Code 44955: Appendectomy performed for a purpose. This is an add-on code that would be reported with another major procedure surgery code. For example, in preparation for a cholecystectomy, a diagnostic study also revealed an appendicolith located in the appendix. If the surgeon performs both the removal of gallbladder along with the appendix, then the add-on code 44955 is appropriate with the open cholecystectomy code (47600). Keep in mind that a diagnosis of appendicolith would support this appendectomy code.

CPT Code 44960: Appendectomy for ruptured appendix with abscess or generalized peritonitis. This CPT code captures a more complicated appendectomy.

Possible Scenarios
The coding needs to be supported by the patient’s story. Inquiring minds wants to know why the laparoscopic procedure was converted to open? What was the main reason for the surgery (remove cecum or appendix)? The following potential scenarios rely on the real story.

Scenario 1: Patient admitted for a partial cecectomy (supported by a diagnosis) and an incidental appendectomy was performed.

The code for partial cecectomy (44140) would be the only code necessary since the appendectomy was incidental. Of course, I am assuming that it was a routine cecectomy with anastomosis.

Scenario 2: Patient admitted for partial cecectomy (supported by diagnosis) and the appendix was also removed due to acute appendicitis.

The code for partial cecectomy (44140) along with the add-on code 44955 (Appendectomy for a reason) would be appropriate.

You see? It all depends on the story.

Disclaimer

The focus of this article is on application of CPT coding and supportive documentation, not billing. Appropriate use of modifiers, referencing NCCI edits and payer specific guidelines is a function before billing services.

 

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About the Author

Gail Smith, MA, RHIA, CCS-P
Gail Smith, president of Gail I. Smith Consulting, is a nationally recognized coding educator. For most of her career Gail was an associate professor and director of the health information management (HIM) program at the University of Cincinnati and HIM program director at Cincinnati State Technical and Community College. Gail is a currently a consultant with a software company specializing in medical terminologies. Gail has authored several textbooks, including Basic Procedural Terminology and HCPCS Coding published by the American Health Information Management Association (AHIMA).   An advocate for advanced coder training, Gail is the author of several titles for Libman Education including CPT: Introduction to Procedural Coding and two courses on the unique challenge of CPT coding in the pediatric setting: CPT for Pediatrics and CPT for Pediatrics: Advanced Orthopedic Coding. According to Gail: “One cannot possibly teach every coding scenario a coder will experience in their career. That is why coding education needs to focus instead on how to arrive at an accurate and defensible code assignment. It is the difference between learning to fish, and being given a fish. If you learn to code instead of being given answers to memorize, you will be able to arrive at the complete codes more quickly and with greater confidence.”

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