Laparoscopic Appendectomy CPT Code

Laparoscopic Appendectomy CPT Code (2022) Description, Guidelines, Reimbursement, Modifiers & Examples

Laparoscopic Appendectomy CPT code (CPT 44970) bills for service when the physician performs a Laparoscopic surgical appendectomy. The physician performs surgery to remove the appendix. 

Laparoscopic Appendectomy CPT Code Description

The physician places a trocar at the umbilicus and insufflates the abdomen. The laparoscope sets through the umbilical port, and additional trocars incorporate into the abdominal cavity. 

The appendix is identified and dissected from surrounding structures and divided blood supply. The appendix is transected with staples or sutures and removed. The trocars remove, and the incisions are closed.

The appendix presents on the right lower side of the abdomen. It is a miniature, tube-shaped pouch attached to the large intestine. The actual function of the appendix is still unknown, and it may help prevent inflammation, infections, and diarrhea of the large and small intestines. 

The physician commonly performs appendectomy to treat appendicitis, inflammation, and swelling of the appendix. If it remains untreated, the possibility of rupture or burst may lead to death or other health hazards. 

The following are the types of appendectomy when performed by the physician:

In an open appendectomy, the physician makes a large incision about 1 to 2 inches on the right lower quadrant near the belly button. After that, the physician removes the appendix. 

In laparoscopic removal of the appendix, the physician makes a tiny incision compared to an open surgical removal. The physician incorporates a long tube into the body via a small incision comprising a video camera and surgical tool. After that, the appendix removes by the physician with the help of a monitor screen. 

cpt code for laparoscopic appendectomy

Laparoscopic Appendectomy CPT Code Reimbursement 

A maximum of one unit can be a bill on the same service date of Laparoscopic Appendectomy CPT code 44970. In contrast, the two units allow when documentation supports the medical necessity of the service.  

The cost and RUVS of CPT 44970 are $657.38 and 18.99602 when performed in the facility. In contrast, the reimbursement and RUVS of Laparoscopic Appendectomy CPT code 44970 are $657.38 and 18.99602 when performed in the non-facility. 

Laparoscopic Appendectomy CPT Code Modifiers  

The following are the list modifiers applicable with Laparoscopic Appendectomy CPT code 44970: 

  • 22, 23, 47, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79, 80, 81 82, 99, , AS, CC, CR, ET, EY, GA, GC, GK, GR, GU, GY, GZ, KX, Q5, Q6, QJ, SG, TC, XR, XP, XU, XS, AI, AQ, AR. 

Modifier 47 is applicable CPT 44970 when the surgeon administers general or regional anesthesia to the patient. It is not appropriate to report modifier 47 with anesthesia procedures.

Modifier 76 is appropriate with Laparoscopic Appendectomy CPT code 44970 when a similar service performs by the Same Physician on the same service date. 

Modifier 54 is applicable with CPT 44970 when the physician provides surgical care only. In contrast, Modifiers 55 and 56 attach to CPT 44970 when the physician performs post-management and preoperative care only. 

Modifier 76 is applicable with CPT 44970 when a similar service performs by a different Physician on the same service date. 

Modifier 59 is applicable with Laparoscopic Appendectomy CPT code 44970 when a Distinct service performs by the physician and bundles with another procedure on the same date.   

Modifier X {E, P, S, U} is applicable instead of Modifier 59 with CPT 44970  when service bills to medicare insurance. It divides the modifier into four parts for further specification of the procedure. 

Modifier 53 will be reported with CPT 44970  if an unsuccessful attempt for an appendectomy makes due to unavoidable circumstances like allergic reactions to the substance. 

Modifier 22 applies to Laparoscopic Appendectomy CPT code 44970 when services perform longer than usual and take extra resources during the procedure. 

Modifier 23 is applicable with CPT 44970  when general or local anesthesia administers by the physician and routinely does not require during the procedure. 

Modifier 52 applies when the physician does not complete the immunization service and terminates due to unavoidable circumstances. 

If physicians believe that Medicare will deny such service, reporting with a GA modifier is appropriate. The beneficiary must sign an Advance Beneficiary Notification (ABN), and CPT 44970 must apply the GA modifier to that service.

cpt code laparoscopic appendectomy

Laparoscopic Appendectomy CPT Code Billing Guidelines

Documentation should support the medical necessity of service. It reflects that service is medically necessary and appropriate.   

 The following are ICD 10 Payable Dx codes when Laparoscopic Appendectomy CPT code 44970 bills: 

C18.1, C78.5, C7A.020, D01.1, D12.1, D37.3, D49.0, K35.20, K35.21, K35.30, K35.31, K35.32, K35.33. K35.80, K35.890, K35.891, K36, K37, K38.0, K38.1, K38.2, K38.3, K38.8, K38.9, R10.823, and R19.03.

CPT 44970 includes diagnostic service (CPT 49320).CPT 49320 does not appropriate to report separately, and the modifier is also not allowed according to NCCI.

If the physician performs diagnostic service only, It is appropriate to report with CPT 49320 instead of CPT 44970.  

If the physician performs an open appendectomy, It is appropriate to report with CPT 44950 instead of CPT 44970.  

If appendectomy performs in conjunction with another significant surgical service, it is appropriate to report with CPT 44955 instead of 44970 in addition to the primary procedure. 

Laparoscopic Appendectomy CPT code 44970 has 90 days global period and a major surgical procedure. It includes one day before surgery, surgery day including 90 days postoperative period. 

Suppose the same physician performs evaluation and management (E/M) service for a reason related to surgery. It is not appropriate to report E/M CPT code 99202-99499 separately.

If the same physician performs E/M (99202-99499) for a condition unrelated to surgery, It is appropriate to report with modifier 25

Laparoscopic Appendectomy CPT Code Example

The following are examples when CPT 44970 bills:

Example 1

An eighteen-year-old male with no past medical history now presents with severe pain in the right lower quadrant. The pain was started seven days ago and got worse with movement. The patient did not take any medication for pain. 

The patient denies headache, blurry vision, itching, dryness,  dizziness, chest pain, shortness of breath, motor weakness, numbness/tingling, nausea/vomiting, and urinary bladder issues.

Physicians order diagnostic services such as CT and MRI of the abdomen and pelvis region. Diagnostic studies revealed that the patient has acute appendicitis. The patient’s condition is getting worse, and has the possibility of appendix rupture or spreading infections to the other organs. 

The physician consulted with Gastrentrologyst for further proceedings and suggested immediately removing the appendix from the body. He schedules an appointment for an appendectomy by tomorrow.

Example 2

A Thirty-year-old male with no past medical history now presents with severe pain in the right lower quadrant. The pain was started two days ago and got worse with movement. The patient did not take any medication for pain.

The patient denies headache, blurry vision, itching, dryness,  dizziness, chest pain, shortness of breath, motor weakness, numbness/tingling, nausea/vomiting, and urinary bladder issues.

Physicians order diagnostic services such as CT and MRI of the abdomen and pelvis region. Diagnostic studies revealed that the patient has acute appendicitis. The patient’s condition is getting worse, and has the possibility of appendix rupture or spreading infections to the other organs. 

The physician consulted with Gastrentrologyst for further proceedings and suggested immediately removing the appendix from the body. He schedules an appointment for an appendectomy by tomorrow.

Example 3

A forty-six-year-old male with no past medical history now presents with severe pain in the right lower quadrant. The pain was started four days ago and got worse with movement. The patient did not take any medication for pain. 

The patient denies headache, blurry vision, itching, dryness,  dizziness, chest pain, shortness of breath, motor weakness, numbness/tingling, nausea/vomiting, and urinary bladder issues.

Physicians order diagnostic services such as CT and MRI of the abdomen and pelvis region. Diagnostic studies revealed that the patient has acute appendicitis. The patient’s condition is getting worse, and has the possibility of appendix rupture or spreading infections to the other organs. 

The physician consulted with Gastrentrologyst for further proceedings and suggested immediately removing the appendix from the body. He schedules an appointment for an appendectomy by tomorrow.

Example 4

A Twenty-year-old male with no past medical history now presents with severe pain in the right lower quadrant. The pain started yesterday and got worse with movement. The patient did not take any medication for pain.t. 

The patient denies headache, blurry vision, itching, dryness,  dizziness, chest pain, shortness of breath, motor weakness, numbness/tingling, nausea/vomiting, and urinary bladder issues.

Physicians order diagnostic services such as CT and MRI of the abdomen and pelvis region. Diagnostic studies revealed that the patient has acute appendicitis. The patient’s condition is getting worse, and has the possibility of appendix rupture or spreading infections to the other organs. 

The physician consulted with Gastrentrologyst for further proceedings and suggested immediately removing the appendix from the body. He schedules an appointment for an appendectomy by tomorrow.

Example 5

A Thirty-three-year-old male with no past medical history now presents with severe pain in the right lower quadrant. The pain was started six days ago and got worse with movement. The patient did not take any medication for pain.

The patient denies headache, blurry vision, itching, dryness,  dizziness, chest pain, shortness of breath, motor weakness, numbness/tingling, nausea/vomiting, and urinary bladder issues.

Physicians order diagnostic services such as CT and MRI of the abdomen and pelvis region. Diagnostic studies revealed that the patient has acute appendicitis. The patient’s condition is getting worse, and has the possibility of appendix rupture or spreading infections to the other organs. 

The physician consulted with Gastrentrologyst for further proceedings and suggested immediately removing the appendix from the body. He schedules an appointment for an appendectomy by tomorrow.

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