General Surgery Coding Alert

Question: The surgeon performed the following procedure for a patient with an abdominal mass and obstruction: percutaneous needle core biopsy of retroperitoneal mass, open temporary bypass ileostomy, and repair of recurrent incisional hernia. How should we code this?

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Answer: You should report the biopsy using 49180 (Biopsy, abdominal or retroperitoneal mass, percutaneous needle) because you specified a percutaneous approach. The best choice for the bypass ileostomy is most likely 44310 (Ileostomy or jejunostomy, non-tube), although more thorough documentation might indicate a different code.

You shouldn’t typically separately report a hernia repair in the surgical field of another abdominal procedure. But you might be able to separately bill the service with a code such as 49565 (Repair recurrent incisional or ventral hernia; reducible) if you have good documentation indicating that the surgeon would not have repaired a hernia in that location in the normal course of exiting the abdomen.