My group needs a little help. One of our docs is reporting 44970-22 and 49084-59. The insurance is paying for the ruptured appendix removal but they are not liking the 49084 for the lavage.
Is the 49084 appropriate to report with 44970? I have always had some reservations about this when you look at the code description in CPT because essentially when the 49084 is getting billed, it is because they are doing a ‘washout’ at the end of the procedure. That just seems included, especially when the appendix ruptured. Below is the op report. Should we be reporting the 49084 in cases like this? Should washouts be included in cases like this?
Thanks in advance for your help. It is greatly appreciated!!!

Through these ports, dissecting forceps were used to take down inflamed mesentery and omentum from a frankly necrotic appendix.The patient had incomplete rotation of the colon resulting in a high right upper quadrant retrocecal appendix. Upon complete takedown of the inflammatory tissues, there was copious amount of feculent fluid and associated intraabdominal abscess. This fluid was placed in a Leuken’s trap and sent to microbiology for culture and sensitivity. The mesoappendix was then taken down using and Enseal device and the appendiceal base was ligated with a 0 Vicry endo loop and transected. The appendix was placed in an endo-catch bag and brought through the suprapubic port site without incident. The appendiceal stump was inspected and found to be hemostatic without evidence of leak. The abdomen and pelvis was then irrigated with approximately 2,000 ml of warm lactated ringers solution. A 19 fr round fluted was then placed in the pelvis, brought out through the 5mm port site and secured using 3-0 ehilon sutures. The ports were removed under direct visualization and abdomen desufflated.