General Surgery Coding Alert

Question: The surgeon performed a laparoscopic inguinal hernia repair on the right side using mesh. He also documented the following: “The dissection was carried out, reducing the indirect hernia and separating the round ligament from the iliac vessels. A small femoral hernia was also discovered and reduced. A double mesh repair was performed using two separate polypropylene mesh patch prostheses. The first mesh was cut with a lateral slit inserted in position covering all the hernia orifices. The second was then placed over top.”

How should I code this?

Tennessee Subscriber

Answer: First, you should code the inguinal hernia repair as 49650 (Laparoscopy, surgical; repair initial inguinal hernia). Because the surgeon used the same mesh to cover all orifices, including the newly discovered femoral hernia, you should not report an additional code.

Consideration: If the surgeon had to use a separate piece of mesh to repair the femoral hernia, you could potentially submit a separate code for that repair. CPT® does not include a code for laparoscopic femoral hernia repair, so your only choice would be 49659 (Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy).