# Lap Roux-en-y gastric bypass w/ Hiatal Hernia



## amny1212@yahoo.com (Jul 25, 2012)

PLease Help!

Hi Everyone,I am a fairly new coder that was just given bariatric surgeries.I am completely stumped on a code selection I am hoping someone can shed some light and advise.

Procedure: Laparoscopic Roux-en-y gastric bypass  and primary Hiatal Hernia Repair. 

This procedure,when performed,is the hiatal hernia inclusive or saparately billable?
If so, I've chosen the following: 43644,39599 (?not sure?)

I asked for help from my co-worker (more experienced) and she gave me 43644,43332
I am not comfortable with that either. 

I asked another co-worker and was given 43644,43280.

I tried to get as much info as possible but its very limited.

I understand Coding is very ambiguous, but I would greaty appreciate your thoughts and advise.

thanks in advance everyone!


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## wcarmignani (Jul 25, 2012)

Without a full redacted note its hard to say but unless they actually did a laparotomy to fix the hernia 43332 is out. Also hiatal's are often repaired by fundoplication (stomach wrap) where I'm assuming they probably dealt with the hiatl in this case by dissecting and reducing without a wrap as I've had a few like that. In my opinion if the hernia had to be fixed in order to complete the bypass then it shouldn't be reported. As for a modifier 22 being appended for the extra work of dealing with the hernia I can't say. There is this regarding from the NCCI policy but it's not directly on point:

6. If a definitive surgical procedure requires access through diseased tissue (e.g., necrotic skin, abscess, hematoma, seroma), a separate service for this access (e.g., debridement, incision and drainage) is not separately reportable. For example, debridement of skin to repair a fracture is not separately reportable.

But from that it seems to me the logic is if you need to "fix" the hernia to complete the bypass you don't report it.


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## amny1212@yahoo.com (Jul 25, 2012)

THANK YOU so much for replying and the clarification wcarmignani, i so appreciate it!


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