Practice Management Alert

Question: Encounter notes indicate that an adult patient presents to the surgeon for repair of left inguinal hernia and gall stones. The surgeons performs an open cholecystectomy for the gall stones and open inguinal hernia repair. How should I report this encounter?

Kansas Subscriber

Answer: You should be able to report a pair of codes for the procedures, provided you include the proper modifier. On the claim, report:

• 47600 (Cholecystectomy) for the cholecystectomy.
• 49505 (Repair initial inguinal hernia, age 5 years or older; reducible) for the hernia repair.
• Modifier 59 (Distinct procedural service) or XS (Separate structure) appended to 49505 to show that the surgeries were separate procedures. (Which modifier you choose will depend on the payer; some still like to see modifier 59, while others prefer the X modifiers.)
• K80.20 (Calculus of gallbladder without cholecystitis without obstruction) appended to 47600 to represent the patients gall stones.
• K40.90 (Unilateral inguinal hernia, without obstruction or gangrene, not specified as recurrent) appended to 49505 to represent the patient’s hernia.

Explanation: Normally, you wouldn’t be able to report cholecystectomy and hernia (abdominal wall) repair for the same patient during the same encounter. Typically, a hernia repair is bundled into a procedure like a cholecystectomy, and the payer would expect that the surgeon would repair any abdominal wall injury as part of the closure for the cholecystectomy.

A surgeon cannot approach an inguinal hernia through the same incision as a cholecystectomy, however, so the procedures should be considered distinct from each other in this instance.