General Surgery Coding Alert

You won't have to rely on unlisted procedure codes -- and unpredictable reimbursement -- anymore. Any time a general surgeon laparoscopically repairs a ventral hernia, coders are faced with the same problem. With no specific code to describe the procedure, you-re forced to submit an unlisted code, which means extra documentation work for you, a slower turnaround time on your claim, and a reimbursement guessing game. But your future should look brighter in January, because CPT 2009 is adding several new hernia repair codes. Here's what you need to know to get the most out of these new codes as soon as they take effect on Jan. 1. Get to Know the New Codes In addition to the two laparoscopic repair codes for inguinal hernias (49650, Laparoscopy, surgical; repair initial inguinal hernia and 49651, ... repair recurrent inguinal hernia), you-ll now have a total of six new codes to choose from when your general surgeon performs a laparoscopic hernia repair. The codes are differentiated by the type of hernia the surgeon fixes, as follows: -49652 -- Laparoscopy, surgical, repair, ventral, umbilical, spigelian, or epigastric hernia (includes mesh insertion, when performed); reducible -49653 -- Laparoscopy, surgical, repair, ventral, umbilical, spigelian, or epigastric hernia (includes mesh insertion, when performed); incarcerated or strangulated -49654 -- Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); reducible -49655 -- Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); incarcerated or strangulated -49656 -- Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); reducible -49657 -- Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); incarcerated or strangulated. "The new codes fall into very standard groupings that coders will be comfortable with using," says Charlotte T. Tweed, RHIA, CPC, inpatient coder in the department of medical education/coding at Florida Hospital in Orlando. Good news: Coders agree that these new codes are helpful and will make their jobs easier. "A code which accurately describes a procedure always makes coding easier," says Joseph A. Lamm, office manager for Stark County Surgeons in Massillon, Ohio. "Basically, any time you can get away from an unlisted code is a good thing." "Many of us have been doing hernia repairs laparoscopically for a long time and this is such a common procedure that it makes sense that repairs done this way finally have their own code," adds Lynn Woolard, practice manager for General and Vascular Surgery in Elgin, Ill. Don't Lean on the Unlisted Code Anymore Old way: Before CPT 2009 added these codes, you had to use unlisted lap code 49659 (Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy) for all lap hernia repairs, except initial inguinal and recurrent inguinal, Tweed explains. "In the past, these procedures were coded as an unlisted code, which [...]