tci Medicare Compliance & Reimbursement - 2011 Issue 17

Reader Question: Don't Expect Payment For 'Healthy' Appendectomy

Question: I heard that Medicare will not pay separately for the removal of a healthy appendix. Is this true? Why not?Answer: Yes. Sometimes a surgeon will remove a healthy appendix simply because he already has the patient's abdomen open and removing the appendix eliminates a potential health problem down the road. Thus, appendectomies during the course of more extensive abdominal procedures are not totally unusual. For example, the surgeon may remove a patient's appendix during bariatric surgery (for example, 43846, Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb [150 cm or less] Roux-en-Y gastroenterostomy)...

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