General Surgery Coding Alert

Question: What code would you use for the removal of an infected Marlex Dual Mesh by laparotomy that was previously placed at a hernia repair? Also included in the procedure was drainage of an intra-abdominal abscess and debridement of the wound. How does this affect the coding?

Pamela Griffith
Sugar Land, Texas

Answer: The removal of a foreign body from the peritoneal cavity is bundled with the drainage of the abscess, so you would only bill code 49020 (drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess; open) to cover everything that was done, says Barbara Cobuzzi, MBA, CPC, CPC-H, a coding and reimbursement specialist in Lakewood, N.J.

If the procedure is performed during the global period for the original hernia surgery, make sure modifier -78 (return to the operating room for a related procedure during the postoperative period) is appended to code 49020. One possible diagnosis code for this return to the operating room could be code 998.59 (other postoperative infection; postoperative abscess, intra-abdominal, stitch, subphrenic, wound or septicemia). The patients chart is required to select a more definitive diagnosis code.