Gastroenterology Coding Alert

Question: My gastroenterologist performed laparoscopic release and repair of an incarcerated internal hernia of the small intestine. Should I bill an unlisted code such as 49659?

New York Subscriber

Answer: Unlisted code it is, but you should report 44238 (Unlisted laparoscopy procedure, intestine [except rectum]) instead of 49659 (Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy). The lap hernia codes (49650- 49659) describe laparoscopic repair of hernias in the abdominal wall. Your situation involves an internal hernia in the small intestine, and CPT does not provide a specific code for it.

Another way: If your gastroenterologist performed an open release and repair of an incarcerated internal hernia of the small intestine, you would still use a code that involved the "intestines," would be 44050 (Reduction of volvulus, intussusception, internal hernia, by laparotomy).

-- Clinical and coding expertise for this issue provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the AMA's CPT Advisory Panel.