Coding, Classification & Reimbursement

1.  TAH w/Appendectomy

Posted 10-09-2017 12:41
Hi All,
We have recently hired 2 OB/GYN physicians who perform appendectomies with most of their TAH's.  They do these regardless of the type of Hysterectomy they perform, Open or Lap.  My questions is, do you or do you not code the Appendectomy in CPT?  There has been, rarely, if ever, any clinical indication for the appendectomy.

I am coding for the hospital, but there is a CPT Assistant from April 1997 that answers "Common Questions" about some global OB codes.  In that article, it gives the example to use the CPT code in a Total Abdominal Hysterectomy, the physician reports 44955 Appendectomy; when done for indicated purpose at time of other major procedure (not a separate procedure), as a secondary procedure.  This is the only place I have found the CPT code being used.  All other articles I found said incidental appendectomies are not coded in CPT.  I am leaning toward not coding the Appendectomy in CPT, since there is no medically necessary reason for it, but I wanted to get some other opinions.

Thanks for any help!

Kayla Hill, RHIA
Director of Health Information/Privacy/CDI

2.  RE: TAH w/Appendectomy

Posted 10-10-2017 10:19

It was my understanding that incidental appectomy of a normal appendix is not billable.  I don't remember where I read this but doubt if the rule has changed.  Any other thoughts on this??

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3.  RE: TAH w/Appendectomy

Posted 10-10-2017 10:48
Dear Kayla,

If there is no medical necessity indicated for the removal of the appendix, then I would not code it since we as coders are unable to code a procedure that has no medical necessity documented. If the appendectomy is for a medical reason and there is no code that includes it in the TAH, then I would code the appendectomy as secondary since the main reason for the procedure is most likely the TAH.

Jodi Miller, RHIT, CCS

Jodi Miller, RHIT, CCS
St Mary Medical Center
Outpatient Coder/Abstractor

4.  RE: TAH w/Appendectomy

Posted 10-10-2017 13:06
In regard to coding for the appendectomy, ACOG has stated that the appendectomy should NOT be billed as a separate service, unless there was a separately identifiable "reason" for it to be removed.  (eg, appendiceal abscess,) which goes hand in hand with the "indicated purpose)  eg... medical necessity to bill for it.    However, your physicians are probably removing it prophylactically, since they were "already in there". 

What we are doing in that respect, is we request that the physician document the appendectomy as a 'prophylactic appendectomy" at the time of hysterectomy.  

L  :)

Lori-Lynne A. Webb
AHIMA ACE Mentor, AHIMA.PCAP Board Member
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5.  RE: TAH w/Appendectomy

Posted 10-17-2017 12:22
​Thank you for your replies!  I didn't think it was supposed to be coded, but wanted a second opinion to make sure!

Kayla Hill, RHIA
Director of Health Information/Privacy/CDI

6.  RE: TAH w/Appendectomy

Posted 10-18-2017 07:47
I did not see anything further in the CPT Assistant but I did see the following two sources which provide support in not coding the prophylactic/incidental appendectomy.  If you search for this on the internet there are also several Super Coder articles that state the same thing.

The National Correct Coding Policy manual states the following:

A medically necessary appendectomy may be reported separately. However, an incidental appendectomy of a normal appendix during another abdominal procedure is not separately reportable.

NCCI Policy Manual 2017, Chapter 6, Section E

Per the CPT book under code 44950 Appendectomy the note says the following:
"Incidental appendectomy during intra-abdominal surgery does not usually warrant a separate identification"

Allison Evans, RHIA
Coding Manager