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Open ing hernia repair excision of cord lipoma

MEZIESKY

Networker
Messages
87
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0
Help please. We have a surgeon that that keeps insisting there is a code for removal of a cord lipoma when he does a inguinal hernia repair. Op not will read; Care was taken to identify and protect the ilioinguinal nerve from harm.
The cord structures were carefully isolated at the pubic tubercle and a penrose drain was passed around them. A cord liipoma was carefully isolated from the cord structures and was ligated and excised. The hernia sac was separated from the cord structures. The hernia was found to be reducible...ect.
He will do this with the open procedure and the lap procedures.
Any thoughts? Is this a truley a separate procedure or part of the hernia repair?
Thank you
mg
 
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81
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Procedure code 55520 is a (Seperate Procedure) code and would be considered bundled with the hernia code. The surgeons I code for also do these procedures but we can only bill for the hernia...Hope this helps..:)
 

salCCS

Networker
Messages
98
Location
Hollywood, CA
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Spermatic cord lipoma. In the July 2000 CPT Assistant, the AMA clarified that when a patient comes to the ASC for an inguinal hernia repair and a spermatic cord lipoma is excised in the same operative session, coders can assign a separate code for the spermatic cord lipoma. "The procedures are considered distinct,"I find a lot of ASC coders are still not reporting that separately. They look at it as part of the inguinal hernia repair and end up leaving money on the table."




When a physician performs a hernia repair (usually an inguinal hernia) procedure at the same time as the excision of a lesion (usually a lipoma) from the spermatic cord (same surgical case), report CPT code 55520 with modifier -59 because the 2010 CPT Manual designates this as a separate procedure. When billing an ASC claim, report HCPCS code C1781 for the hernia mesh (unless billing to Medicare, as it considers the mesh inclusive in the CPT code for the hernia repair procedure).
 

MEZIESKY

Networker
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87
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0
Still confused. I am reading it as bundled also. The Ingenix Coding Companion I have says. This is a separate procedure by definition is usually a component of a more complex service and is NOT identified separately. But I do NOT see it listed under the CCI edits as being bundled ???
mg
 

cmartin

Guru
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204
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The CCI edits very carefully state that not every code pair that shouldn't be billed together is listed, that :
If a CPT code descriptor includes the term “separate procedure”,
the CPT code may not be reported separately with a related
procedure. CMS interprets this designation to prohibit the
separate reporting of a “separate procedure” when performed with
another procedure in an anatomically related region often through
the same skin incision, orifice, or surgical approach.
- Policy Narratives Chapter One (J) Pg.I-27 Revised 1-1-2012
I think that there are differences between what ASCs can bill and what surgeons can bill, so we should be careful about following each other's rules.
 

sferguson

Guest
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33
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0
Not bundled

55540 is what I use when they do both. I always had to write off the seperate 55520 even with a 59 modifer. This code pays.
 
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