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Q&A: Coding for appendiceal stump syndrome

JustCoding News: Inpatient, February 1, 2012

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QUESTION: A physician admits a 30-year-old male with lower abdominal pain. A CT scan showed consistency with perforated appendicitis. However, the patient had an appendectomy 10 months prior. The physician documents "appendiceal stump syndrome." How should I code this case?

ANSWER: Stump appendicitis is a rare, delayed complication following an appendectomy (open or laparoscopic). It is characterized by acute inflammation of the residual appendix. Stump appendicitis results from obstruction of the lumen of the remaining appendix, usually by a fecalith.

It is commonly misdiagnosed due to the patient’s history of appendectomy. The clinical indications are very similar to acute initial appendicitis, such as right lower quadrant pain, nausea and/or vomiting, and fever.

From a coding standpoint, there is no entry in the Alphabetic Index of the ICD-9 Manual for this condition nor any existing specific Coding Clinic guidance, but you would likely assign code 997.49 (other digestive system complications) and code 543.9 (other and unspecified diseases of the appendix). You would not assign a separate code for the lower abdominal pain as it is a symptom of a more definitive disease process.

Editor’s note: Shannon McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS, director of HIM and coding at HCPro, Inc., in Danvers, MA, answered this question. Interested in learning more from this coding expert, sign up to participate in The JustCoding Virtual Summit: ICD-10-CM and ICD-10-PCS, which will take place February 29–March 2. Shannon McCall will be one of the speakers during this three-day event, during which you will have the opportunity to hear from an array of experts, who will share guidance for the challenges of ICD-10 preparation and implementation. You will also be able to network with your peers and participate in question and answer sessions—all without ever having to leave your office.

This answer was provided based on limited information submitted to JustCoding. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

Need expert coding advice? Submit your question to Managing Editor Doreen Bentley, CPC-A, and we’ll do our best to get an answer for you.

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