A surgeon performs a laparoscopic appendectomy but converts it to an open procedure – how do you code it?
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When a laparoscopic appendectomy converts to open—How do you code it?
In medical coding, when a planned laparoscopic appendectomy must convert to an open procedure, coding guidelines are clear: only the open procedure is reported. According to the NCCI Policy Manual and AAPC, if a laparoscopic surgery is converted intraoperatively to an open approach, you report the completed open appendectomy, not the laparoscopic attempt.
CPT guidance: Use CPT code 44960 for an open appendectomy (e.g., ruptured appendix with peritonitis) or 44950 for simple open appendectomy. You do not report the laparoscopic code 44970. Modifier –22 may be added to reflect unusual or additional work, if well-documented; but the laparoscopic code still isn’t reported.
ICD-10-CM diagnosis: First, code the underlying condition—e.g., K35.200 (acute appendicitis with generalized peritonitis, without perforation or abscess). Then add Z53.31 to indicate “laparoscopic surgical procedure converted to open procedure."
ICD-10-PCS (Inpatient Procedures): For the procedure itself, use the open appendectomy code 0DTJ0ZZ (Resection of Appendix, Open Approach). Guidelines mandate coding only the open version when conversion occurs.
Stats & context: A 2025 JAMA Surgery study analyzing over 110,000 appendectomies (2021–2023) found that only 2.8% were performed open, and 25.9% involved complicated disease. The study supports modernizing CPT structures to more accurately reflect surgical work.
Quality Thought
This coding scenario exemplifies Quality Thought—valuing precision, consistency, and clarity in coding decisions. For your Medical Coding Course, teaching students that "only the completed procedure is reported" aligns with coding integrity and avoids billing errors. Emphasizing proper use of modifiers, diagnosis sequencing, and accurate PCS coding strengthens their competence and ethical coding mindset.
Our courses help Educational Students master such real-world coding challenges through:
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Practical examples like laparoscopic-to-open conversions
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Clear guidelines, with reference to NCCI, AAPC, CPT, and ICD-10-CM/PCS
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Quality-focused lessons that reinforce coding accuracy and integrity
By honing their Quality Thought, students not only pass exams but also contribute to accurate claims, safer patient care, and more reliable data.
Conclusion
In summary: report only the open appendectomy (CPT 44960 or 44950; PCS 0DTJ0ZZ), add diagnosis K35.200 plus Z53.31 for conversion, and use modifier –22 only when justified. This approach teaches students the importance of precision—truly a mark of Quality Thought in coding practice. Ready to build this scenario into your next lesson module?
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