General Surgery Coding Alert

Question: A patient is seen with acute bowel obstruction. He has a strangulated hernia, which at operation releases and no resection is needed. The hernia is repaired. Medicare will pay bowel obstruction as an independent procedure only, and thus hernia will not be paid. Is there any way we can get payment for half of hernia?

H. Subramanian, MD, N.Y.

Answer: Because no resection was performed, the only procedure that can be billed is the hernia repair. There should be no expectation of payment for a resection that wasnt performed, says Susan Callaway-Stradley, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C.

For example, when an inguinal hernia on an adult male patient is repaired, code 49507 (repair initial inguinal hernia, age 5 years or over; incarcerated or strangulated) would be billed. In the situation described in the question, the bowel obstruction did not require a resection, but if it had, then only the resection could be billed, and the repair of the hernia would be considered incidental, Callaway-Stradley says.