General Surgery Coding Alert

General surgeons who expected CPT 2002 to include a code for reporting laparoscopic repair (LR) of ventral/incisional hernias, take note: Continue to use unlisted-procedure code 49659 (Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy) to report this procedure.
 
Although CPT 2002 includes two codes for LR of inguinal hernias 49650 (Laparoscopy, surgical; repair initial inguinal hernia) and 49651 ( repair recurrent inguinal hernia) it does not include a code for LR of ventral/incisional hernias. These complications commonly develop after a patient has had open abdominal surgery, and they often require surgical repair. Fascia and skin are sutured closed after surgery. When the fascial repair breaks down, an incisional hernia forms. These are typically seen as a bulge (arising through the fascial defect) deep to the visible skin scar.
Traditional/Open Repair
Traditional/open repair involves reopening the original surgical incision, placing sutures and (often but not always) covering the abdominal wall fascial defect with a prosthetic mesh.
 
Codes for reporting traditional/open repair of ventral/incisional hernias include 49560 (Repair initial incisional or ventral hernia; reducible), 49561 ( incarcerated or strangulated), 49565 (Repair recurrent incisional or ventral hernia; reducible) and 49566 ( incarcerated or strangulated).
  Consider the following when coding these traditional/open procedures:
 
Has a prior repair been performed? If this is the first incisional hernia repair performed at the site, an initial" repair was performed. Subsequent repairs are considered "recurrent" and are typically more difficult than an initial repair. Use 49560 or 49561 for initial repairs and 49565 or 49566 for subsequent ones.
 
How severe is the hernia? "Reducible" hernias are typically less dangerous and easier to correct. "Incarcerated or strangulated" hernias can be life-threatening. Use 49560 or 49565 for the former and 49561 or 49566 for the latter. 
 
Note: Although a ventral/incisional hernia is the result of a prior incision it may be reported inappropriately as "recurrent" when actually it is the first time this problem is being addressed. If a ventral/incisional hernia is repaired at the same time as a recurrent one at a separate site and is medically necessary report it separately with modifier -59 (Distinct procedural service) appended.

Laparoscopic Repair
LR differs from traditional/open repair in that the mesh is placed from inside the abdomen rather than from outside.
 
Although LR is more difficult and costly than traditional/open repair many general surgeons opt for this method (especially for large and complex hernias) because 1) the results of traditional/open repair are not always satisfactory 2) LR's risk of complication is lower 3) its hospital stay is shorter and 4) LR [...]