Gastroenterology Coding Alert

Question: A surgeon worked on a patient to repair a reducible umbilical hernia. During the procedure, she finds a sizeable gallstone embedded in the omentum extending into the preperitoneal fat. The surgeon excises the gallstone granuloma with cautery.Patient history indicates cholecystectomy eight years ago. What ICD-9 and CPT codes should I bill?New York SubscriberAnswer: You should code 49585 (Repair umbilical hernia, age 5 years or older; reducible). If the gallstone resection represents a significant amount of extra time and effort, then append modifier 22 (Increased procedural services).Careful: You're risking a denial if you report the omentum gallstone resection (49255, Omentectomy, epiploectomy, resection of omentum [separate procedure]) in addition to the 49585 hernia repair. Why? As a designated "separate procedure" code, you should only list 49255 if it is the only procedure the surgeon performs at the site. Similarly, you should not report the service as a peritoneal foreign body removal [...]