General Surgery Coding Alert

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.

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.

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 has no assigned RVUs," Lamm agrees. "This left reimbursement up to the insurance companies, and reimbursements were all over the board. We would try to

provide a comparable code to the payers, but there isn't any code that is truly comparable."  "We can only hope that the changes are positive ones and that the new reimbursement rates associated with these codes will accurately reflect the skill

and extra work involved in using the laparoscopic technique," Woolard says. Check out the box to the left to see the reim-bursement you can expect these new codes to bring in.

Another plus: Having assigned codes will also help with the time you spend preparing a claim and also reduce the time it takes payers to reimburse you for these procedures. "The addition of these codes will be such a major timesaver for just

about anyone who does general surgery coding," Tweed says. Whenever you submit an unlisted code you must also send along the operative report, a letter explaining the procedure the surgeon performed, comparing the procedure to another

procedure with an assigned code, and the fee you expect to be reimbursed. You won't have to do this extra work thanks to the new 2009 codes.

"We have six general surgeons, all of whom perform laparoscopic hernia repairs," says LeAnne Walters, CPC, certified coder for Cypress Healthcare Partners in Monterey, Calif. "Currently I must use the unlisted hernia codes, and send in the

operative reports along with an unlisted coding form we developed to assist the insurance carriers in processing our claims. Not having to submit documentation will be an extra benefit of the new codes."

Bonus: When you were coding with unlisted codes, you had to send in documentation and wait for the payer to review your claim, delaying your payment. "With an assigned code, the claim can be sent electronically without the need for

documentation, and turnaround should be in days, not weeks or months," Lamm says.

As the descriptors of the new hernia repair codes indicate, these procedures include mesh insertion and you cannot separately code for the mesh, much to the dismay of coders. "The use of mesh can create additional operative time for the

surgeon and I feel it should be separately reportable and reimbursable, just as it is for the open hernia repairs," Walters laments.

Pay attention: "Mesh coding remains a stumbling block for many coders new to general surgery," Tweed says. "The AMA has addressed the mesh question with the additional informational description of each new code ["includes mesh

insertion, when performed"]. As long as the coder reads the entire description, they should not have a problem. They will not try to somehow add mesh on either by using the unlisted code or incorrectly using the mesh code for open

incisional/ventral hernia repair."