General Surgery Coding Alert

Question: The surgeon excised Prolene mesh from an inguinal hernia site for chronic pain. The procedure was extensive and lasted longer than the original hernia repair. Should I use 49085 (Removal of peritoneal foreign body from peritoneal cavity) to report this procedure? Michigan Subscriber Answer: The excision of the mesh certainly qualifies as removal of a foreign body. The correct code, however, is 27087 (Removal of foreign body, pelvis or hip; deep [subfascial or intramuscular]). Code 49085 is for removal of a foreign body from within the abdomen. Because this removal is performed from the outside, a 20000-series code is used. Use 27087 because the mesh was removed from an inguinal site. If the foreign body was in an abdominal site but accessed from outside, use 20525 (Removal of foreign body in muscle or tendon sheath; deep or complicated). Note: The pelvis marks the border between the "inguinal" and "abdominal" areas. Below the pelvis is inguinal, above is abdominal. The inguinal site from which the mesh is removed is considered muscle. Code 27086* (Removal of foreign body, pelvis or hip; subcutaneous tissue) should not be used because it describes more superficial foreign-body removals. If the foreign body is removed because of infection, 996.69 (Infection and inflammatory reaction due to other internal prosthetic device, implant, and graft) is the correct diagnosis code. If the mesh is not infected but causes pain or malfunctions and must be removed, use 996.59 (Mechanical complications of other specified prosthetic device, implant, and graft; due to other implant and internal device, not elsewhere classified).