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Bowel resection with hernia repair

  1. #1
    Default Bowel resection with hernia repair
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    I have a very small section of bowel that was removed within the course of a hernia repair. How would you code this? I am not sure whether to consider it incidental, and the notes aren't great. Please help.

    ...Visiport was used to gain access to the peritoneal cavity. Under direct vision, additional trocars were placed in the axillary line bilaterally. The hernia was identified. A complex hernia sac containing many loops of bowel was noted, which had extensive redundant skin. It was then opened by creating a set of elliptical skin incision and was carefully taken through the incarcerated bowel. The bowel was densely adherent in several locations and the best solution, as the bowel could not be freed from the complex loculated hernia sac, was to resect approximately one-inch of bowel between a GIA staple line. The defect was closed with a TA stapler. After noting there to be no other evidence of incarcerated bowel and after noting the parameter to be clear, the midline fascia was then re-closed with #1 looped PDS suture and soft tissues approximated with Vicryl.

    Thank you for your help in advance :0)

  2. Default
    Maybe: 44202-52 (-52 for no anastomosis) OR 44238 with 49653 (-51 if needed). I don't see any edits for these codes so I'd bill it. Payer might have a policy but I appeal with info below.

    CPT Assistant June '08 states "Hernia repair codes report the repair of the hernia only. Any excision or repair of strangulated organs or structures, if performed, would be reported with a separate code(s) in addition to the code for the hernia repair."

    Good Luck!

  3. #3
    You should check with the surgeon. I think he did a bowel resection with an anastomosis but it's not dictated very well. If so, then I would use 44120.

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