Gastroenterology Coding Alert

Question: The surgeon is doing an open hernia repair through a small incision. He repairs the hernia and then puts in a port using the same incision for a lap chole and repairs this as well. I usually would use the conversion to an open procedure diagnosis code V64.41. But this case  isn't a conversion from lap to open, but open to lap. How do I report this type of procedure?

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Answer: In this case, you cannot separately report the hernia repair. That's because you can't code for the repair of a hernia (an abdominal wall defect) when your surgeon performs another procedure through the same part of the abdominal wall.

Why: The abdominal wall would have required repair once the surgeon completed the other procedure. You could add modifier 59 (Distinct procedural service) and separately bill the hernia only if your surgeon performed the repair at a different site than the other procedure's incision (for example, an inguinal hernia).

Tip: If the hernia repair leads to significant additional work -- and if your surgeon documented that extra time and effort -- you can use modifier 22 (Increased procedural services).

In a circumstance like the one you describe, there is no need to report any extra diagnosis information.Code V64.41 (Laparoscopic surgical procedure converted to open procedure) is really important only when the case has become extra difficult because the physician started the procedure laparoscopically but then had to convert to open because of poor exposure or adhesions or some other reason (which often necessitates a great deal of extra work).

In this case, you can report only the open code. Code V64.41 helps to justify modifier 22 for the extra effort before the surgeon converted the procedure.