Lap Chole with Repair of abdominal hernia

[carol52]

Dr. Performed a Lap Chole..
The patient had an umbilical hernia, the umbilical stalk was circled with a clamp and the umbilical stalk was dissected off the hernia sac.
Trocars were placed in the abdomen and the gallbladder was removed and was brought out through the infra umbilical incision
The Trocars were removed and then Dr. repaired the hernia defect with 0 Vicryl sutures
I coded the 47563 for the Lap Chole w/ Cholangiogram.. can I code for the repair of the Umbilical hernia ( 49591) ?
Thanks
Carol

 

[nsteinhauser]

CPT ASST May 2021:
Question: At the time of a laparoscopic cholecystectomy, the surgeon discovered a previously undiagnosed umbilical hernia. The surgeon extended the surgical incision of one port site to repair the umbilical hernia. May both procedures be reported?
Answer: No, only report the 47562. By convention, when a laparoscopic cholecystectomy is performed, the approach is always through the umbilical area. If there is a defect (eg, umbilical hernia), then it is repaired as part of the closure of the umbilical port incision. No additional code should be reported for repair of the umbilical hernia.

There wasn't a cholangiogram in this example but the idea is the same.
Hope that helps.

 

[carol52]

Can you please explain the umbilical stalk circled and clamped and dissected off the hernia sac.
This was before the Trocars are placed , is this part of the hernia removal or is that included in the repair of the hernia defect ?
thanks
Carol

 

[EmilyC]

You cannot code the umbilical hernia. They place trocars in or near the umbilical area during a lap chole, and they close up the umbilical hernia while removing the trocars, on the way out, therefore, it's part of the closure and it's not separately reportable. Insurance will also deny it. I've never seen insurance cover it, even when it was planned in pre op to repair both.