# Please help can 47562 and 49585 be billed out together



## bmkardok (May 25, 2012)

Hi Everyone, I do not do a lot of hard coding and I am wondering if I am billing this note out correctly. I would appreciate if anyone had advise.

PREOPERATIVE DIAGNOSIS: 
Biliary colic. 
Umbilical hernia. 

POSTOPERATIVE DIAGNOSIS: 
Biliary colic. 
Umbilical hernia 

OPERATION: 
Laparoscopic cholecystectomy. 
Primary repair of umbilical hernia. 

FINDINGS: ANESTHESIA: General. 

BLOOD LOSS: Minimal. 

COMPLICATIONS: None. 

PROCEDURE: The patient was brought to surgery and had a smooth induction of general 
endotracheal anesthesia. The abdomen was prepped and draped sterilely after placement 
of bilateral sequential pressure devices, and administration of prophylactic 
antibiotics perioperatively. A supraumbilical curvilinear incision was accomplished. 
Dissection was carried down, mobilizing the hernia sac off the undersurface of the 
umbilical skin. The sac was then entered, allowing placement of the balloon tipped 
trocar. Epigastric and 2 right subcostal 5 mm ports were placed under direct vision. 
The gallbladder fundus was grasped and elevated over the liver. The infundibulum was 
grasped and distracted laterally and inferiorly. The peritoneum was lysed 
circumferentially. The lower portion of the gallbladder was mobilized up off the 
liver bed creating a large window and then further dissection centrally was 
accomplished until the cystic artery and duct were visualized circumferentially. They 
were clipped and transected. The remaining attachments of the gallbladder to the 
liver were taken using electrocautery. It was removed without spillage through the 
umbilical port site. 

Right upper quadrant was inspected and found to be hemostatic. A small piece of 
Surgicel was placed at the distal edge of the gallbladder fossa in an area that had 
previously had some oozing. The abdomen was desufflated and the ports removed. The 
umbilical fascia was closed with 2 figure-of-eight #1 Prolene sutures, and the knots 
from these were then buried under additional soft tissue. All skin incisions were 
closed with 4-0 Vicryl. Dressings were applied. She tolerated this well and was brought from the operating room in good condition.

Can procedure codes 47562 an 49585 be billed out for this note?

Thanks!


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## dmaguire (May 25, 2012)

The two can not be billed together.  The rational is that when they are doing a lap procedure and reparing the umblical hernial it is inclusive to the origonal procedure.   Hope this helps.


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## bmkardok (May 25, 2012)

Thanks. That's what I needed to know.


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## bda23054 (May 25, 2012)

Med Assets says there are no bundling issues with the two codes above.


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## dyates (May 25, 2012)

I disagree that the two codes are bundled.  If you run the two codes thru CCI edits it shows that both can be billed out.  Please give written documentation as to why the approach would be included for a hernia and a cholecystectomy.

Diana


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## cynthiabrown (Jul 18, 2014)

you will find your answer in the NCCI policy manual for medicare services  Chapter VI   E4 digestive system. it is not billable


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