Background: In spite of improvement in modern diagnostic technology, diagnosis of appendicitis based on clinical suspicion, leads to removal of normal appendix. Sometimes, Modified Alvardo Score system is helpful in minimizing the same. Aim: To evaluate the sensitivity and specificity of Modified Alvarado Score (MAS) and Ultrasonography (USG). Material and Methods: 350 patients suspected of acute appendicitis were admitted, investigated and treated. They were evaluated using Modified Alvarado Scoring and all cases were subjected to ultrasonography. The sensitivity and specificity of Modified Alvarado Score and Ultrasonography were correlated with histopathological findings. Results: Modified Alvarado score >7 was seen in158 patients in whom 151(95.60%) had histopathologically proved acute appendicitis and 7 (4.43%) patients were histopathologically negative. Modified Alvarado score <7 was observed in 192 patients among whom 81 (42.19%) were histopathologically proved acute appendicitis and 111 (57.81%) patients were histopathologically negative. Among 158 with Modified Alvarado Score > 7, 152 (96.2%) were ultrasonographically diagnosed as acute appendicitis and 6(3.8%) patients were ultrasonography negative. Among 192 patients those with Modified Alvarado Score <7, 97 (50.52%) were ultrasonographically diagnosed as acute appendicitis and 111 (57.8%) patients were histopathologically negative. Conclusion: An application of Modified Alvarado Scoring system and USG preoperatively as a protocol in patients with suspected appendicitis, the sensitivity is 98.44% for MAS and 98.33% for USG and specificity is 94.4% for Modified Alvarado Scoring and 90% for USG. In acute appendicitis, MAS is a good diagnostic indicator, and it is highly sensitive in diagnosis of appendicitis. Combined use of MAS and USG is very effective in diagnosis of appendicitis and it helps in reducing number of negative appendicectomy.