Gastroenterology Coding Alert

Question: Our GI surgeon performed a laparoscopic partial colon resection with anastomosis for ischemic bowel. During the procedure, he identified a right inguinal incarcerated hernia that was not reducible, so he laparoscopically resected the hernia sac and used mesh to repair the abdominal wall. Can we report both 44140 and 49507? What about the mesh?

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Answer: You can report both services, but based on the information you’ve provided, you appear to be selecting the wrong codes.

Because the procedure is laparoscopic, you should report 44204 (Laparoscopy, surgical; colectomy, partial, with anastomosis) instead of 44140 (Colectomy, partial; with anastomosis) for the partial colectomy procedure.

Don’t miss: The correct code for the laparoscopic hernia repair is 49650 (Laparoscopy, surgical; repair initial inguinal hernia). As with the colectomy, you should not choose the open code for the hernia repair, such as 49507 (Repair initial inguinal hernia, age 5 years or older; incarcerated or strangulated).

Identify incidental: Many coders are hesitant to report a hernia repair in addition to another abdominal surgery because they’ve heard that the hernia repair is always “incidental” in these cases. But that’s not always true. In fact, you can separately report a hernia repair with another abdominal procedure code when the hernia site is not the same as the abdominal procedure, or the hernia repair is medically necessary for cases such as a strangulated hernia.

Check bundling: Double check Medicare’s Correct Coding Initiative (CCI) edits to see if you’re restricted from coding the two procedures together. In this case, CCI does not bundle 49650 and 44204. That means you shouldn’t need to use a modifier to report these two codes together.

This case states that the physician placed mesh as part of the hernia repair, but that doesn’t mean you should automatically add +49568 (Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair)) to your bill. In fact, CPT^®  codes for laparoscopic hernia repair and many open hernia repair procedures other than ventral and incisional hernias include mesh placement, when performed. That’s because placing mesh is so common in those procedures that the codes include the mesh value in the established payment.

Caution: Some GI physicians resist the idea that they can’t separately report the mesh placement and try to use +15777 (Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure)) instead of +49568. You shouldn’t do that, because +15777 is only for use with other integumentary codes.