One of my General Surgeons and one of my Orthopaedic Surgeons performed a very difficult and unusual surgery. I am having trouble picking the appropriate coding. The procedure performed was a repair of a right flank bulge with existing mesh and fixation to the iliac crest. The patient had a nephrectomy in 2003 and subsequently developed an incisional hernia. It was initially repaired in 4/2003. This repair was not successful, so another surgeon attempted re-repair in 6/2003. The mesh was free floating and not attached. The same surgeon attempted the 3rd repair in 11/2003 and it appeared that the mesh had shrunk. The mesh was recorded as only 2 cm and the hernia sac was protruding superiorly and inferiorly around this mesh. A new sheet of Marlex was placed and suture secured to his 11th & 12th ribs and pelvis using 3-0 nylon suture. Again the patient presented in 6/2006 and it was found that the mesh was secured superiorly, but free floating down below. It was resecured down to the periosteum of the iliac crest. All of these surgeries took place through a right flank incision.
The only 2 options that I can come up with is to either use an unlisted code and assign an appropriate fee, or to use the recurrent incisional repair code with modifier 22. The patient has Medicare. The fee and reimbursement that is associated with the hernia repair doesn't seem to match the extensive time, work and skill involved, even with the modifier 22 appended - especially considering this was a primary and assistant surgeon situation. Billing the unlisted code puts us at risk of not getting very much, if any reimbursement at all. Is there another code or another way to go about getting my surgeons a reasonable reimbursement?