Ob-Gyn Coding Alert

Reader Questions:

Payer Will Guide You For This Cesarean, Hernia Scenario

Question: Our doctor did a cesarean on a patient and noticed a hernia that he repaired while in there. How would I code that? This is a Medi-Cal patient, so it also might not be covered separate from the cesarean procedure. FINDINGS: Male infant delivered from a vertex presentation with Apgars and weight still pending. The amniotic fluid was clear. The placenta had a 3-vessel cord and intact membranes. The uterus, fallopian tubes, and ovaries were without gross abnormalities. There was an incisional hernia that involved at least 50% of the incision. The patient had had an ultrasound earlier in the pregnancy to rule out a hernia. She was complaining of a lump in her lower abdomen. The ultrasound returned as negative for hernia, but on today’s incision, there is indeed a hernia. The omentum was stuck to the subcutaneous tissue for at least 50% of the incision.

What should I do?

California Subscriber

Answer: Many times the procedure is considered like a tummy tuck after cesarean, but you will have to check with Medi-Cal rules on this. If the hernia was part of the current incisional area, the chances are good that you will not get paid for hernia repair as a separately billed procedure. However, if the repair was more difficult due to it being there, you might be able to make a case for using modifier 22 (Increased procedural services) on the delivery code you are reporting (59514, Cesarean delivery only).

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