# CAN I CODE UMBILICAL HERNIA REPAIR/NGUINAL HERNIA REPAIR? Please help me



## KBean2018 (Apr 15, 2019)

Hello, Need Clarification.
According to CCI edits, 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 shall not be reported separately.   Based on the below procedure, I could only code 49650 right? To me it looks like the same incision. But the edit states 49560-49566, 49652-49657 and there is no conflict with CCI checker. 

PREOPERATIVE DIAGNOSIS:  Nonincarcerated right inguinal hernia.  Nonincarcerated umbilical hernia.
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FINDINGS: Tiny subcentimeter umbilical hernia with a thickened umbilical dermis and no apparent umbilical hernia sac.  Moderate sized nonincarcerated indirect right inguinal hernia.  Moderate cord lipoma.
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PROCEDURE: Laparoscopic repair of nonincarcerated right inguinal hernia.  Open repair of umbilical hernia.
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An infraumbilical curvilinear incision was performed exposing a subcentimeter umbilical fascial defect.  The umbilical dermis was actually thickened and there was not a hernia sac.  Through the fascial defect a Veress needle was inserted and the abdomen was insufflated to 15 mmHg pressure using carbon dioxide.  The a 11 mm Surgiport was then placed through the umbilical defect.  2 5 mm ports were placed lateral to the rectus muscles at the umbilical plane, bilaterally.
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The patient was then placed Trendelenburg left lateral tilt position exposing the right lower quadrant.  Adhesions of the cecum were taken down from the anterior lateral abdominal wall.  The appendix was visualized and appeared normal.  A transverse peritoneal incision was made in a routine manner, superior to the inguinal canal.  An inferior flap was created.  Cooper's ligament was dissected and identified.  The vas deferens and spermatic vessels were identified and protected throughout the case.  The spermatic cord was dissected and a moderate size cord lipoma was reduced, excised and removed from the abdomen via an Endo Catch device.  An indirect hernia sac was also reduced.  This left a moderate size indirect hernia defect.  The medial posterior inguinal floor was intact.
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A Bard, 3-dimensional low-density polypropylene mesh was then inserted and placed within the preperitoneal pocket.  It was tacked to Cooper's ligament x3 with the absorbable tacker.  It was tacked superior to the transversalis fascia again using multiple absorbable tacks.  With the mesh in excellent position and no evidence of bleeding, the pocket was reperitonealized by tacking the inferior peritoneal flap to the anterior abdominal wall using the absorbable tacks.

The ports were then removed under direct vision.  There is no bleeding port sites.  The abdomen was desufflated.  The umbilical fascial defect was closed with a figure-of-eight 0 Vicryl suture
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## cgaston (Apr 15, 2019)

KBean2018 said:


> Hello, Need Clarification.
> According to CCI edits, 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 shall not be reported separately.   Based on the below procedure, I could only code 49650 right? To me it looks like the same incision. But the edit states 49560-49566, 49652-49657 and there is no conflict with CCI checker.
> 
> PREOPERATIVE DIAGNOSIS:  Nonincarcerated right inguinal hernia.  Nonincarcerated umbilical hernia.
> ...



They inserted the needle and the port through the umbilical defect so it is part of the inguinal hernia procedure and cannot be billed separately. 

Not making an additional cut and using the umbilical hernia defect is most likely the best thing for the patient. In this case following "best practice" disallows the extra reimbursement.


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## KBean2018 (Apr 15, 2019)

*Thank you*

I really appreciate the clarification  Have a nice day


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## Srikanth235 (Jul 2, 2019)

hi can you anybody please give clarification wether the CPT 49585 is inclusive in the cPT 47563


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## cgaston (Jul 2, 2019)

There are no CCI Edits between these two codes.  However -- if the physician inserts the needle/port through the umbilical defect then the repair is considered part of the 47563 since they would have to close a port site for a laparoscopic surgery anyway.


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