General Surgery Coding Alert

Question: Our surgeon operated on a patient with recurrent inguinal hernia. The mesh placed during the original surgery had to be removed due to infection. Is removal of the infected mesh considered part of recurrent hernia surgery or can I report it separately?

Texas Subscriber  Answer: Youre unlikely to find consensus among payers on this issue because there is no single rule governing these circumstances. In any case, what you can code (and expect reimbursement for) depends largely on the strength of the surgeons documentation.
 
In most instances, you should be able to make a case for reporting both 49520 (Repair recurrent inguinal hernia, any age; reducible) for hernia repair and 27087 (Removal of foreign body, pelvis or hip; deep [subfascial or intramuscular]) for mesh removal. Often, if a previous meshed hernia becomes infected, the surgeon will first remove the infected mesh, then wait to be sure that the infection does not recur. If, after sufficient time to allow healing, the infection does not recur and scarring has not already obliterated the hernia, he or she will then return to the operating room to repair the hernia. Here, you can bill 27087 for the first surgery and 49520 for the second surgery.
 
If circumstances call for the surgeon to remove the mesh and repair the hernia during the same operative session (as appears to be the case in the question above), you can still claim both 27087 and 49520 as long as documentation makes clear the extent and difficulty of the procedure. Some payers may argue that mesh removal is included in recurrent hernia repair, but the effort involved in removing the mesh is clearly beyond that usually associated with simple repair. If you provide documentation stating, for instance, Removal of mesh from infected area required an additional 40 minutes of operative time, you can increase your chance for fair reimbursement substantially. In some cases, you may even be able to append modifier -22 (Unusual procedural services) to 27087 if the mesh removal is especially difficult or time-consuming, although you must provide accompanying documentation that justifies the modifiers use and include a separate cover letter with the claim explaining the special circumstances of the surgery.