Wiki Inguinal hernia repair w/excision of spermatic cord lipoma

[hpycoder]

Should you always bill both inguinal hernia repair and excision of spermatic cord lipoma together ? The surgeon typically finds a lipoma of the cord and excises it during the hernia repair. When would that service be considered independent from the actual hernia repair? I have been billing the service w/mod 59 appended. Some payers reimburse, others will not and consider the service bundled. I want to be correct going forward. Thanks for any input coders

 

[jojokat]

You might consider using the XS modifier as the spermatic cord is part of the male reproductive system and not the muscular system or abdominal area. The only issue we have with this is when the hernia repair is laparoscopic because there is not a lap code for the removal of a spermatic cord lesion and we have to use the unlisted code for the lesion.

 

[thomas7331]

In my opinion, the modifier 59 would not be appropriate unless the excision of the lesion was performed through a separate incision or during a separate operative session from the hernia repair.

The bundling edit on these two procedures is based on the CPT 'separate procedure' designation on CPT code for the excision of spermatic code lipoma. Per CPT instructions, a code with this designation is one that is "commonly carried out as an integral component of a total service or procedure" and should only be reported separately with a modifier when it is"a distinct, independent procedure. This may represent a different session, different procedure or surgery, different site or organ system, separateincision/excision, separate lesion, or separate injury (or area of injury in extensive injuries)."

Cord lesions are very commonly removed during many inguinal hernia repair surgeries, and billing routinely as a separate procedure would be considered inappropriate unbundling unless the documentation supports it is distinct from the main procedure and medically necessary as a separate surgery.