The appendix is a 3 1/2-inch-long narrow tube of tissue that projects from the large intestine on right side of the abdomen. Appendicitis is an inflamed appendix, which is removed via an appendectomy, a common emergency operation that medical coding outsourcing companies help surgeons code and report for maximum reimbursement.
Appendicitis – Causes and Symptoms
The earlier theory was that the appendix served no particular purpose. According to a report published in the Science Daily in 2017, recent research suggests that the appendix could have the important function of serving as a reservoir for beneficial gut bacteria.
Appendicitis occurs when the appendix becomes blockedby stool, a foreign body like food, or cancer. An infection in the body can make the appendix to get blocked and swell. The pain due to appendicitis typically begins around the navel and then moves to the lower right abdomen. The pain increases as the inflammation worsens and eventually becomes severe, requiring emergency surgery. The typical symptoms of appendicitis include:
- The first sign is a dull ache near the navel or the upper abdomen that progresses into a sharp pain as it moves to the lower right abdomen
- Loss of appetite, nausea and/or vomiting
- Abdominal swelling
- Pain during urination
- Inability to pass gas
Other symptoms include dull or sharp pain anywhere in the upper or lower abdomen, back, or rectum, severe cramps, and constipation or diarrhea with gas
Appendicitis must be treated promptly as an inflamed appendix can perforate or burst, causing infectious materials to spill into the abdominal cavity. This can result in serious inflammation of the abdominal cavity’s lining, a condition known as peritonitis, which can become fatal if it is not treated quickly. This is the reason why all cases of appendicitis are treated as medical emergencies.
Approaches to Appendectomy
- Open appendectomy: The traditional approach, open appendectomy involves removal of the appendix through an incision in the right lower abdominal wall. The patient is usually administered general anesthesia. Care is taken to prevent spilling of the pus from the appendix while it is being removed. The incision is then closed with sutures and leaves a scar. In the event of rupture (peritonitis), the abdomen will be cleaned of pus using a warm saline solution. A drain is placed to allow the pus to drain out. The skin is packed with sterile gauze and is left open so that the pus can drain out completely.
- Laparoscopic approach: In this approach, the surgeon uses alaparoscope to view the patient’s internal organs on a television screen and perform the operation through small incisions. This safe and efficient procedure offers clinical advantages over the open method such as less post-op pain, lower risk of wound infection, shorter hospital stay, possibly quicker return to bowel function, lower rate of wound infection, faster return to normal activity and work, and better aesthetic outcomes. However, in some patients, the laparoscopic method is not feasible because of the difficulty to visualize or handle the organs effectively. In such cases, the surgeon may convert the laparoscopic procedure to an open one.
Reporting Appendix Procedures
Appendectomy is considered a Once in a Lifetime procedure since each person has only one appendix and can have only one appendectomy during his or her lifetime. When a single physician or multiple physicians or other health care professionals report a single code from the Appendectomy Code Family, it will be reimbursed only once during a patient’s lifetime.
The CPT codes for reporting appendectomy are:
- Appendectomy – Open
44950 Appendectomy; incidental during intra-abdominal surgery
44955 Appendectomy; when done for indicated purpose at time of other major procedure (not as separate procedure) (To be listed separately in addition to code for primary procedure)
44960 Appendectomy; for ruptured appendix with abscess or generalized peritonitis
- Appendectomy – Laproscopic
44970 Laparoscopy, surgical, appendectomy
44979 Unlisted laparoscopy procedure, appendix
- Other Codes
44900 Incision and drainage of an appendiceal abscess through an open incision
44901 Drainage of appendiceal abscess
49406 Image-guided fluid collection drainage by catheter (e.g., abscess, hematoma, seroma, lymphocele, cyst); peritoneal or retroperitoneal, percutaneous for a percutaneous image-guided drainage by catheter of an appendiceal abscess.
ICD-10 Codes for Appendicitis
CPT procedure codes should be reported along with the appropriate ICD-10 codes. The ICD-10 codes for appendicitis are as follows:
K35 (acute appendicitis)
- K35.2 (acute appendicitis withgeneralized peritonitis)
- K35.3 (acute appendicitis with localizedperitonitis)
- K35.8 (other and unspecified acuteappendicitis)
- K35.80 (unspecified acuteappendicitis)
- K35.89 (other acute appendicitis)
K36 (other appendicitis)
K37 (unspecified appendicitis)
K38 (other diseases of appendix)
- K38.0 (hyperplasia of appendix)
- K38.1 (appendicular concretions)
- K38.2 (diverticulum of appendix)
- K38.3 (fistula of appendix)
- K38.8 (other specified diseases of appendix)
- K38.9 (disease of appendix, unspecified)
Points to Note while Documenting Appendectomy
- Choose the right standalone CPT code: If appendectomy was solely performed to remove the appendix, the relevant CPT codes are 44950, 44960 or 44970. While 44950 and 44970 stand for open primary appendectomies, 44960 indicates appendectomy for a perforated or ruptured appendix and/or for diffuse peritonitis (ICD-10 code K35.2).
- Laparoscopic appendectomy for perforated appendicitis: If a laproscopic appendectomy is performed and the appendix is perforated or ruptured, report 44970. The June 2, 2018 Bulletin from the American Academy of Surgeons points out that 44970 is the only code that applies to laparoscopic appendectomy and that it is used to report a laparoscopic appendectomy for either situation – with rupture or without rupture.
- Reporting incidental appendectomy: Incidental appendectomy is the removal of a clinically normal appendix during non-appendiceal surgery. The American Medical Association (AMA) instructs that an incidental appendectomy during another intra-abdominal surgical procedure should not be reported separately. For instance, AMA states that “it is a misuse of CPT code 44950 (appendectomy) to report it for an incidental appendectomy during the procedure described by CPT code 58150 (Total abdominal hysterectomy, with or without removal of tube(s), with or without removal of ovary(s)). In this case, CPT code 44950 should be bundled into CPT code 58150”.
- Reporting appendectomy for a medically-indicated purpose: If the appendectomy is performed for a medically indicated purpose, for e.g., if the appendix was involved in the disease process and had to be removed, it can be reported with an add-on code, +449559 (Appendectomy; when done for indicated purpose at time of other major procedure (not as separate procedure) (to be listed separately in addition to code for primary procedure).
- Medical necessity: Appendectomies performed as distinct procedures and reported as medical necessary are reimbursed by most payers. The surgeon’s documentation should indicate the appendix appeared abnormal and had to be removed. The appendectomy should not be reported separately if the appendix was not abnormal in some way and there was no medical necessity for removing it. In this case, the removal of the appendix is incidental to the surgery.
Experienced coders in medical billing and coding companies are knowledgeable about the nuances of reporting this common surgical procedure. They will check the operative report to understand the reason for the appendix removal as well as pathology report and can help surgeons bill appendectomies to maximize reimbursement.