General Surgery Coding Alert

Question: My doctor did a lap hernia repair and placed a mesh. While in there, he found an ovarian mass, so he called in an ob-gyn to do a salpingooophorectomy. After the ob-gyn finished, my doctor went back to close the patient. When he got back he didn't like the looks of the mesh placement -- as if it "dislodged" a bit with the other doc in there -- so he opened the patient, took out the mesh he had just placed, and repaired it again. I am thinking I can only code for what the physician completed, which would be the open hernia, but I don't want to miss anything. What should I report?

Kentucky Subscriber

Answer: First, you're on the right track with your thinking. You are correct that you should just code the open repair (as you would any other conversion from lap to open). So you would report the proper open hernia repair code, such as 49505 (Repair initial inguinal hernia, age 5 years or older; reducible).

Caveat: Remember, you should not also report the code for the laparoscopic procedure. If during a laparoscopic procedure, the surgeon converts to an open surgery, you should only report the open procedure, according to CPT and CMS guidelines. Instead, report just the open procedure code and use V64.41 (Laparoscopic surgical procedure converted to open procedure) as a secondary diagnosis to document on the claim that the surgeon converted from laparoscopic to open technique.

Append modifier 22 (Increased procedural services) to the open hernia repair code for the extra time and work associated with the conversion to open if your surgeon wrote a good op report and provided thorough documentation explaining the clinical situation, along with the extra time and effort the conversion took.

The bad news: Many insurers are going to bundle the hernia repair and the oophorectomy so this becomes a co-surgery. The question doesn't specify the kind of hernia your physician repaired, but you will need to check with the insurance company you're billing to find out their bundling policies. If the payer bundles the hernia repair and oophorectomy codes, you'll have to bill this as a co-surgery with the ob-gyn using just the oophorectomy procedure code and modifier 62 (Two surgeons).

-- Technical and coding advice for You Be the Coder and Reader Questions provided by Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, CPCOBGYN, CPC-CARDIO, manager of compliance education for the University of Washington Physicians (UWP) and Children's University Medical Group (CUMG) Compliance Program.