The laparoscopic appendectomy CPT codes are 44950, 44960, 44970 & 44979. These codes can be reported for an operative procedure performed to remove an inflamed appendix from the body; appendicitis is an issue.
Appendicitis must be treated in an emergency and without delay in this situation. This is because the appendix may burst or rupture at any time, causing a severe threat to life.
Laparoscopic Appendectomy Procedure
The surgery is performed either under general or local anaesthesia, and the patient has to stay in the hospital for 1 to 2 days. In case of an appendix burst, the patient has to stay in hospital for a week.
If the surgeon does not remove the swollen appendix, it may burst to cause an infection in the abdomen called peritonitis.
The laparoscopic or lap appendectomy is an operating procedure, and it is a minimally invasive surgery. In laparoscopic appendectomy, very few tiny incisions are required to remove the appendix, and thus there is more minor injury and less recovery time.
The appendix is a three and a half inches long tissue-tube hanging with the large intestine and is situated on the abdomen’s right side. Appendectomy is emergency surgery, and this condition of the subject is called appendicitis.
When the appendix gets infected or inflamed and is no more required in the body and has also become a cause of threat to the human body, it needs to be removed through a surgical operation in the operating room; this removal of the appendix surgically is called an appendectomy.
Once the surgical operation is performed, the post-surgery treatment starts. But, first, the coder or biller has to make sure that they write the correct CPT codes to receive full-fledged reimbursement without any difficulty and without going through the auditing process.
The CPT (Current Procedural Terminology) code 44970 is employed to mention this laparoscopic appendectomy.
Report CPT 44970 when either the appendectomy-related laparoscopic procedure is performed or incidental, and the physician considers reporting it.
Description Of Laparoscopic Appendectomy CPT Codes
Four different CPT codes may be employed as far as appendectomy is concerned. These codes have a significant difference, but they are related to appendectomy.
The laparoscopic appendectomy CPT codes include;
CPT 44950 is described as the appendectomy performed through an open incision in the abdomen).
CPT 44960 is described as the appendectomy performed through an open incision in the abdomen for ruptured appendix which may have an abscess or general peritonitis.
CPT 44979 is described as Unlisted laparoscopic operating procedures relating to an appendix.
Billing Guidelines For Laparoscopic Appendectomy CPT Codes
Use the CPT 44970 if the laparoscopic appendectomy is performed for the ruptured or perforated appendix. Whether the appendix is just inflamed or is ruptured, then CPT 44970 is billed if the removal of the appendix is carried out by laparoscopy.
Fluoroscopy is included in laparoscopic procedures.
Fluoroscopic guidance (CPT 76000) is not billed separately with laparoscopic procedures. Therefore, both government (Medicare or Medicaid) and commercial payers may deny the claim processing.
Fluoroscopic Guidance (CPT 76001) is no more available and was deleted by CMS (Center for on 1st January 2019.
Suppose the appendix is ruptured with an abscess, and the surgeon has decided to remove the appendix through an open incision surgery in the abdomen. In that case, CPT 44960 is employed for reporting the payer. CPT 44960 is used when no other abdominal operating procedures are being performed.
The CPT 44970 can be reported in the claim when the following scenarios are there:
- A laparoscopic procedure for an appendectomy is performed.
- Appendectomy is secondary and occurs as a result of some other laparoscopic procedure when the surgeon feels necessary.
In the last scenario, the physician may consider it incidental appendectomy and direct the coder or biller to append a specific modifier for the service executed.
According to the guidelines narrated by AMA, the laparoscopic appendectomy can be accomplished during the major laparoscopic procedure if the physician deems it necessary.
And in this scenario, the coder or biller must use the CPT 44979 (described as a laparoscopic procedure that is unlisted and is related to the appendix).
CPT 44970 is associated with other laparoscopic procedures like the codes for treating stress urinary incontinence and prolapse; the CPT codes used for this purpose include 51990, 51991, 51992, 57425, and the CPT codes for sterilization procedures like 58670 and 58671.
The CPT criteria are different for varying sessions, surgical procedures, and various body sites and organs. In addition, the incision and excision, lesion, injuries at other areas may also have different CPT codes. Therefore, the operative report must be prepared after discussion with the surgeon.
The coder must be precise in mentioning CPT codes as per the rules and regulations of the American health care department and the American Medical Association (AMA) for consulting the CPT codes needed for medical billing for the appendectomy operations.
With time and due to the dynamic and haphazard global health issues like epidemics, the CPT codes may change from time to time.
The physicians and the coders or billers have to keep in touch with the rules set forth by the American Medical Association and the coding experts to employ accurate coding in this context.
In addition, they have to continue improving their practice to receive their reimbursement accordingly, losing time and money.
Modifiers For Laparoscopic Appendectomy CPT Codes
Report modifier 59 if the laparoscopic appendectomy (CPT 44970) is performed with the other laparoscopic procedure.
Modifier 59 is a payment modifier and describes as a distinct procedural service. Therefore, the usage of modifier 59 should be supported by medical necessity and proper documentation.
The CPT 44950 represents a stand-alone operating procedure for incidental appendectomy, which may either be separately performed or is unplanned and is performed along with some other major operation.
The coder or biller has to go through the CPT manual & guidelines and make sure that they billed this CPT. For example, if the surgeon removes the appendix for diagnosis and the appendix is not ruptured, then add modifier 52.
Likewise, if an incidental appendectomy is required for some diagnosis while the appendix is normal, it should be accompanied with the modifier 52.
In this case, the surgeon has to satisfy the payer as the payer has the right to review this modifier, and if the surgeon cannot satisfy the payer, the claim may get denied.
If modifier 52 is not appended, it may get tricky for the physician to receive the desired reimbursement by merely billing the CPT 44950.
In this case, the use of CPT 44950 without a modifier may lead to a denial from the payer. Therefore, the coder or biller should ensure the usage of modifier 52 and the CPT 44950 when the appendectomy is accomplished with some other abdominal procedure.
The coder must remember that the reimbursement of funds is a complex procedure and precise codes are necessary for all circumstances.
CPT 44955 is used to indicate an appendectomy performed for an already indicated purpose but when some other abdominal procedure is in process.
For instance, if the appendix has enlarged or has extended with fecal, the CPT code 44955 is used without any modifier as it is an “add-on” CPT code, and it is always billed in connection with other procedures.
Government payers, for instance, Medicare makes reimbursements considering the payment of surgical supplies are included in the payment for the relevant CPT.
The FFS (Fee for Service) for appendectomy CPT codes are:
For facility, the FFS for CPT 44970 is $622. For ASC (Ambulatory Surgical Center), the fee for CPT 44970 is $2306. While for hospital outpatient, the fee is $5060.
The FFS for CPT 44960 is $905 for the facility. And it is not reimbursed for the ASC or hospital outpatient.
For CPT 44950, the FFS is $664 for the facility. For ASC, the fee schedule is $1406. While for hospital outpatient, it is $3183.
For facility, the FFS for CPT 44955 is worth $85 and is not applicable in ASC. CPT 44955 is payable in the hospital outpatient setting.
This is an updated fee schedule for the above procedural codes as per CMS.
The CPT prices may alter as per the government policy in the coming years. Therefore, the physician or coder must keep in touch with the related CMS (Center for Medicare & Medicaid Services) or AMA (American Medical Association) guidelines to ensure that the appropriate reimbursement can be made.
A surgeon is in the operating room and intends to remove a patient’s gallbladder; the CPT code for gallbladder is 47600.
However, during the examination, he finds the appendix inflammation and abnormality and decides to remove that, too, during the surgical procedure.
The coder or biller may bill CPT 44955 with the CPT code for the gallbladder, i.e., 47600. Both CPT codes are billed in separate line items.
And if the physician removes only the appendix, the coder or biller must bill for CPT 44950 only. Because the CPT 49000 (described as abdominal surgery) is already included in CPT 44950.
CPT 49000 (for abdominal surgery) includes CPT 44950 (Appendectomy) and is considered a bundled service.
Therefore, CPT 49000 may not be billed with CPT 49000. Otherwise, the insurance companies may deny the whole claim. Similarly, one cannot bill CPT 44960 with CPT 49000 because the service (CPT 49000) is inclusive of the main service (CPT 44960).
Laparoscopic Appendectomy CPT Code 2016
Laparoscopic appendectomy can be performed in three ways:
1. Open Approach Reporting
If the appendectomy is performed using an open approach when the appendix is normal, it is coded as CPT 44950.
Laparoscopic appendectomy helps remove the appendix with more precision on the part of the surgeon and is less problematic for the patient.
The CPT 44960 is billed for an open appendectomy when the appendix is fully or partially ruptured and/or perforated.
2. Add-on Code Reporting
When a surgeon performs an appendectomy with an add-on approach during a major procedure, the add-on CPT 44955 can be used for accurate billing.
CPT 44955 is not separately payable and should accompany the main service CPT code.
3. Lap Approach Reporting
The surgeon or the coder may use CPT 44970 for Laparoscopic appendectomy when the surgeon uses the laparoscopic approach to get rid of the appendix.
In 2016, the FFS (Fee for Service) for CPT 44970 was $1002.56 and $1247.56 for CPT 44960.
Laparoscopic Appendectomy CPT Code 2020
Surgeons and coders have to improve their practice by keeping in touch with the latest rules and regulations to receive their reimbursements, and the best way to do so is to read the descriptions of the required codes quite often.
The FFS for CPT 44970 in 2020 was $1224.30, and it was $1789.20 for CPT 44960.
It is up to the surgeon and the coder to remain updated with the rules set forth by American Medical Association and American Health Care departments to find precise CPT codes for Laparoscopic Appendectomy.
Laparoscopy With Hernia Repair
Consider the following instance to comprehend this issue.
Question: If a laparoscopic appendectomy occurs after a planned operative procedure of umbilical hernia repair, which CPT codes should be used for billing?
Answer: The CPT 44970 and CPT 49585 may be bundled as per the rules. As per AMA guidelines, they cannot be billed together. However, if another procedure is performed at the same site as the first one, then the other procedure may include the first one.
For example: If the umbilical hernia repair is accomplished at the same site of laparoscopic appendectomy, then the service CPT (for umbilical hernia repair) is included in CPT 44970. Therefore, the coder or biller cannot bill them together.
Suppose the surgeon does not place a trocar (a surgical instrument required to withdraw fluid from a body cavity) in hernia defect. In that case, he can bill them separately with the modifier 59.