Laparoscopic 'component separation' for ventral hernia repair


Clearwater, Florida
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One of our General Surgeons did a Laparoscopic Incisional Hernia with a bilateral fasciocutaneous flap repair, also done laparoscopically. The open code for the fasciocutaneous flap is 15734, but no laparoscopic code exists for this procedure. We assigned the Unlisted Laparoscopy procedure, abdomen, peritoneum and omentum to that portion of the procedure. She responded with this statement: "The 15734 code is neither an open nor laparoscopic code. It is not in the digestive system codes so it is non-discriminatory. I am told it can be used with lap hernia codes and we have successfully done it on [other case]."

She did not state where she was told this, but it has always been my understanding that if a procedure is not specifically labeled as laparoscopic, thoracoscopic, endoscopic or arthroscopic, then it is considered an Open procedure. Unfortunately, it seems that this understanding is so wide-spread that I haven't been able to find anything in writing to use in explaining this to her. Even the layman's terms descriptions don't actually say anything about making an incision down to the tissues being used to form the flaps.

Does anyone know of any resources I can use to explain this to her?
Laparoscopic component separation with lap ventral hernia repair

I am also looking for clarification on this complicated procedure. Some literature suggest to code the lap hernia repair with an unlisted procedure for the lap component separation. Others recommend to code the lap hernia repair with CPT 15734 muscle flap since CPT 15734 doesn't specifically say open. I think since there is no specific guideline we should be coding it on a case by case basis with a prior authorization from the payor because providers are completing a very complicated procedure where there work is not really described in the options given. If anyone has any suggestions, ideas or resources please reply to this post. Thank you!