Claim Edit #029
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Anthem Blue Cross and Blue Shield Central Region Clinical Claim Edit Subject: Exploratory Laparotomy, Open Procedures with Appendectomy Edit# 029 Effective: 08/05/2002 – 12/31/2099 Coverage is subject to the terms, conditions, and limitations of an individual member’s programs or products and the edit criteria listed below. Please compare the claim's date of adjudication to the range of the edit in question. Prior versions, if any, can be found below. Description CODE RULE CODE 49000 + 44955 Bundles and Assigns Code 44950 Rationale Anthem Central Region bundles 49000 with 44955 and assigns code 44950. When an abdominal exploration is performed in which an abnormal condition is found and corrected - the only procedure to be submitted is the code that describes the procedure which corrects the abnormality. When an abdominal exploratory laparotomy (49000) is performed and it is noted that the appendix was abnormal, then the only procedure that should be submitted is 44950. This logic follows the same guidelines as listed by CPT for a surgical laparoscopy-"a surgical laparoscopy always includes a diagnostic laparoscopy. If the physician had performed the exploration, (a diagnostic procedure) found no abnormalities, and just closed the patient - then 49000 would be the appropriate code to be submitted. Since a diseased appendix was found, the appropriate code for the appendectomy is 44950. Therefore, if 49000 is submitted with 44955 - both codes will bundle, and assign the code 44950 - which reimburses. References 1. American Medical Association. Digestive System/Surgery Section. Current Procedural Terminology CPT; 2001: Surgery-162. CLAIM EDIT HISTORY 08/05/2001 Revised 11/05/2001 Adopted Central Region Claim Edit#029 Page 1 of 1 Anthem Blue Cross and Blue Shield is a trade name of Anthem Health Plans, Inc. independent licensee of the Blue Cross and Blue Shield Association ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. CPT © is a registered trademark of the American Medical Association Use of Central Claim Edits: This Edit is subject to federal and state laws, to the extent applicable, as well as the terms, conditions, and limitations of a member’s benefits on the date of service. Claim Edits are constantly evolving and we reserve the right to review and update these edits periodically. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise, without permission from Anthem Blue Cross Blue Shield. .