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
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and the edit criteria listed below. Please compare the claim's date of adjudication to the range of the edit in
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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
11/05/2001
Revised
Adopted
Central Region Claim Edit#029
Page 1 of 1
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