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Urology Coding Alert

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Is 49585 Billable with 55866?

Published on Wed Oct 10, 2012

Question: When, if ever, can I separately report an umbilical hernia repair code (49585) during a Davinci robotic total prostatectomy?Michigan SubscriberAnswer: When closing an open surgical operative wound and at the same time repairing a ventral hernia, the hernia repair becomes part of the closure and a separate charge for the hernia repair should not be made. This clearly and certainly would apply to open surgery. Caveat: When performing laparoscopic surgery and then at the same encounter also openly repairing a ventral hernia as you implied in mentioning code 49585 (Repair umbilical hernia, age 5 years or older; reducible), these procedures should be separately billable. The urologist is using a separate approaches: open for the hernia repair versus laparoscopic for the Davinci robotic total prostatectomy (55866, Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed). Therefore, you should report 55866 and 49585.Additionally, if after an initial operative laparoscopic procedure, [...]
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