Wiki "umbilical hernia repair" with lap chole

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deborahcook4040

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an uneventful lap chole with grams was performed - at the end, my phsycian repaired a 15 cm abdominal wall defect near the umbilicus, which she is calling a hernia. There is no hernia sac to excise. There is nothing protruding through the defect. The relevant portion of the op report goes as follows: "The trocars were removed and the pneumoperitoneum expelled. The fascial defect at the umbilicus was then mobilized. The fascial edges were mobilized using cautery to raise flaps circumferentially. The defect was about 15 cm. The fascial edges were mobilized and reapproximated transversely and closed using running #1 Vicryl. Subcutaneous tissues were irrigated and closed using running 3-0 Vicryl. The skin edges were then closed with running subcuticular 4-0 Vicryl. Prior to closing the skin a pursestring suture of 3-0 Vicryl was placed at the umbilical skin and this was tacked down to the subcutaneous. A sterile pressure dressing was applied."

Should I code this as an intermediate repair or an umbilical hernia repair with a 59 modifier? Usually an umbilical hernia repair would be bundled into the lap chole unless it was incarcerated, but this defect was so big that it seems like it should be seperated out due to the amount of work involved. The defect also predated the procedure and was not involved.

Thanks,

Debby
 
The umbilical hernia repair is actually part of the closure of the Lap Chole so it's not separately reportable. You'll just code the Lap Chole w/IOC (47563) with your GB dx and add the umbilical hernia dx.
 
In that scenario the doctor could possibly bill the lap chole with a -22 to capture the extra work done with the massive defect.
 
Praveen Ravi said:
Can anyone please provide me any standard reference for this scenarios ?? Thanks in advance :)
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Unfortunately there is no uniform standard, as is the case with a lot of issues we deal with. You will need to research each individual payers requirements. Some pay, most do not.

The best guidance I can offer is to verify that the umbilical repair "was actually" a separate procedure. IE through a separate incision. If it's not then for all intents and purposes it will be bundled into the closure of the lap chole.

The 22 modifier is a good mechanism for additional payment in the case outlined above. If you believe strongly enough that the documentation supports a separate procedure you can always submit a redetermination with notes for review.
 
NCCI Policy Manual for Medicare Services VI-8 section E states "If a hernia repair is performed at the site of an incision for an open or laparoscopic abdominal procedure, the hernia repair (e.g., CPT codes 49560-49566, 49652-49657) is not separately reportable. The hernia repair is separately reportable if it is performed at a site other than the incision and is medically reasonable and necessary. An incidental hernia repair is not medically reasonable and necessary and should not be reported separately."
 
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bethh05 said:
NCCI Policy Manual for Medicare Services VI-8 section E states "If a hernia repair is performed at the site of an incision for an open or laparoscopic abdominal procedure, the hernia repair (e.g., CPT codes 49560-49566, 49652-49657) is not separately reportable. The hernia repair is separately reportable if it is performed at a site other than the incision and is medically reasonable and necessary. An incidental hernia repair is not medically reasonable and necessary and should not be reported separately."
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Thank you bethh05 !
 
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