CPT 44900 Incision & Drainage Reimbursement | OpenPayer

Summary & Overview

CPT 44900: Incision and Drainage of Appendiceal Abscess

CPT code 44900 designates the surgical incision and drainage of an appendiceal abscess. This acute surgical procedure is performed to evacuate purulent material, relieve pain, and limit spread of infection, typically in an inpatient hospital setting. Nationally, timely management of intra-abdominal abscesses has implications for patient outcomes, length of stay, and downstream resource use.

Key payers in the national discussion include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for 44900, how the service is commonly delivered, and what benchmarks and policy themes are relevant to coverage and billing. Coverage aspects across major commercial and public payers, common billing considerations, and clinical setting expectations are summarized. The publication also outlines where to find related clinical and coding guidance and highlights common areas that affect claim adjudication and utilization, such as site of service and surgical urgency.

Data not available in the input for payer-specific rates, associated taxonomies, and ICD-10 diagnosis mappings are noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare44900CPTappendiceal abscesssurgical drainagegeneral surgeryinpatientoperating roomprocedure codingbilling guidance

Billing Code Overview

CPT code 44900 describes the incision and drainage of an appendiceal abscess. The procedure involves surgically incising the abscess associated with the appendix and draining purulent material to relieve pain and control local infection.

Service type: Surgical drainage of intra-abdominal abscess related to the appendix
Typical site of service: Hospital operating room or hospital procedural area, often performed by general surgery teams

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult presenting to the emergency department with right lower quadrant abdominal pain, fever, localized tenderness, and an ultrasound or CT scan demonstrating a well-formed appendiceal abscess. The clinical workflow begins with triage and initial resuscitation, intravenous antibiotics, and imaging confirmation. Interventional radiology or a general surgeon evaluates the patient; when percutaneous drainage is not feasible or immediate source control is required, the provider performs an incision and drainage of the appendiceal abscess under appropriate anesthesia. Post-procedure care includes wound care, antibiotic management, culture of purulent material, pain control, and monitoring for sepsis. Documentation supports timing, indication (appendiceal abscess), procedure details (incision, pus drainage, drainage device if placed), anesthesia type, complications if any, and disposition (admission, observation, or discharge with outpatient follow-up).

Coding Specifications

Modifier	Description	When to Use
`00`	Default; no modifier	Used when no other modifier applies to the service.
`11`	Service performed by the billing provider	Used when the primary surgeon or performing provider directly performs the incision and drainage.

Taxonomy Code	Specialty	Notes
`207P00000X`	General Surgery	Most common specialty performing incision and drainage of appendiceal abscesses.
`2080S0002X`	Colon and Rectal Surgery	May manage intra-abdominal abscesses and complex appendiceal disease.
`3356M0002X`	Surgical Critical Care	Manages critically ill patients requiring operative source control.
`363L00000X`	Interventional Radiology	Performs percutaneous drainage as an alternative; collaborates when drainage catheter or image guidance is used.
`207K00000X`	Pediatric Surgery	Performs this procedure for pediatric patients when applicable.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K35.2`	Acute appendicitis with localized peritonitis	Represents acute appendicitis complicated by localized infection and abscess formation; common indication for `44900`.
`K36`	Other appendicitis	Includes atypical or unspecified appendicitis presentations that may progress to abscess requiring drainage.
`K37`	Unspecified appendicitis	Used when documentation does not specify type; may be associated with abscess if imaging supports.
`K65.2`	Peritoneal abscess	Directly relevant when an intra-abdominal abscess related to the appendix is present and requires drainage.
`R10.31`	Right lower quadrant pain	Symptom code commonly present in the clinical record supporting evaluation that leads to diagnosis requiring `44900`.
`A41.9`	Sepsis, unspecified organism	Used when systemic infection or sepsis occurs secondary to appendiceal rupture and abscess, justifying urgent source control.
`K66.1`	Hemoperitoneum (nontraumatic)	Included when intraperitoneal blood is present and complicates abscess management; less common but clinically relevant.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`49083`	Drainage of peritoneal abscess; percutaneous, without image guidance	Alternative percutaneous drainage approach; may be performed by interventional radiology instead of open incision and drainage.
`49084`	Drainage of peritoneal abscess; percutaneous, with image guidance	Used when image-guided catheter drainage is performed for appendiceal abscess management.
`44950`	Appendectomy, partial or total, with or without drainage	Performed when definitive removal of the appendix is undertaken either at the same setting or delayed after abscess management.
`10160`	Puncture aspiration of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess) with or without injection of antibiotic	Used for superficial abscesses; occasionally coded for simple superficial drainage if applicable in the abdominal wall.
`49560`	Drainage of incarcerated or strangulated abdominal wall hernia; complicated abscess or drainage procedures	May be billed if abscess extends into the abdominal wall or in cases with concurrent hernia repair issues.