Gastroenterology Coding Alert

If your office has been performing laparoscopies to repair hernias, rejoice. You just got a set of codes that describe those procedures. The new CPT codes -- 49652-49657 -- replace a series of "S" codes, which should smooth the path to

reimbursement. Medicare doesn't accept HCPCS "S" codes.

In a laparoscopy, the physician makes a small incision, usually in the navel, through which she inserts a viewing tube or laparoscope. It's not unlike an endoscope; the tube has a small camera on the eyepiece that allows the doctor to examine

the abdominal and pelvic organs on a video monitor connected to the tube. Other small incisions can be made to insert instruments to perform procedures. It's less invasive than open abdominal surgery, or laparotomy. The new codes describe

repairs to hernias, which are tears or defects in the muscular wall of the abdomen. The doctor makes small incisions and inserts a synthetic mesh to reinforce the weakened area.

• 49652 " Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); reducible

• 49653 " ... incarcerated or strangulated

• 49654 " Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); reducible

• 49655 " ... incarcerated or strangulated

• 49656 " Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); reducible

• 49657 " ... incarcerated or strangulated.

One more laparoscopy code: CPT 2009 will include 43279 (Laparoscopy, surgical, esophagomyotomy [Heller type], with fundoplasty, when performed), which is a surgical treatment for reflux disease.

The change banishes the need for an unlisted code for this procedure.