Anesthesia Coding Alert

Question: What are the correct surgical and anesthesia codes, modifiers, and diagnosis codes to report for the following case?

Anesthesia: General; ASA II
Post-op diagnosis: Incarcerated upper quadrant ventral hernia
Procedure: Laparoscopic ventral hernia repair

Op report: 36-year-old female with initial repair of 6 cm incarcerated ventral hernia. A small incision was made near hernia defect and a trocar was placed. Pneumoperitoneum was established for laparoscope introduction. Additional incisions were made for inserting surgical instruments. Scar tissue was excised, and skin and fat dissected off the hernia sac. Adherent omentum and bowel were dissected off the inner surface of the hernia sac and freed from the abdominal wall. The part of the intestine trapped in the hernia sac was repaired; tissue maneuvered back into normal anatomical position. A mesh implant was placed over the defect and abdominal incisions closed. There were no operative complications.

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Answer: The AMA updated the hernia codes in 2023 to distinguish between initial or recurrent, reducible or incarcerated/strangulated, and repair size. The approach is no longer a determinant for coding the surgery, although it may still apply to anesthesia codes.

Surgery code: To pinpoint the correct CPT^® code you must know certain details about the hernia including location, total defect size, and whether the abdominal contents can easily be returned to their original compartment (reducible vs. incarcerated). This patient had a 6 cm incarcerated ventral hernia, so you’d report 49594 (Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implantation of mesh … total length of defect(s); 3 cm to 10 cm, incarcerated or strangulated).

ASA code: When you crosswalk the surgical code, you’ll find four anesthesia code options:

• 00790 (Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; not otherwise specified), base 7
• 00752 (Anesthesia for hernia repairs in upper abdomen; lumbar and ventral (incisional) hernias and/or wound dehiscence), base 6
• 00832 (Anesthesia for hernia repairs in lower abdomen; ventral and incisional hernias), base 6
• 00840 (Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; not otherwise specified), base 6

Tip: When coding by taking the surgical code and crosswalking it to an anesthesia code, you should choose the most applicable code with the highest base unit value.

In this case, the term “omentum” in the op note guides anesthesia coders to “intraperitoneal procedures in the upper abdomen,” which includes laparoscopy and has a base value of seven units. So you’d submit 00790 and append modifiers AA (Anesthesia services performed personally by anesthesiologist) and P2 (A patient with mild systemic disease).

Diagnosis: Report the incarcerated ventral hernia with K46.0 (Unspecified abdominal hernia with obstruction, without gangrene). The list of synonyms for this code includes “Unspecified incarcerated abdominal hernia.”