General Surgery Coding Alert

Question: What code should I use for the removal of an infected Marlex dual mesh by laparotomy that was previously placed at a hernia repair? Also included in the procedure was drainage of an intra-abdominal abscess and debridement of the wound.

Texas Subscriber

Answer: Because the removal of a foreign body from the peritoneal cavity is bundled with the drainage of the abscess, you would code only 49020 (drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess; open) to cover everything, says Barbara Cobuzzi, MBA, CPC, CPC-H, an independent coding and reimbursement specialist in Lakewood, N.J.

If the procedure is performed during the global period for the original hernia surgery, make sure modifier -78 (return to the operating room for a related procedure during the postoperative period) is appended to 49020. One possible diagnosis code for this return to the operating room could be 998.59 (other postoperative infection; postoperative abscess, intra-abdominal, stitch, subphrenic, wound or septicemia). The patients chart is required to select a more definitive diagnosis code.

Note: If the removal of the Marlex mesh required significant additional time (i.e., 25 percent of the entire session), additional payment may be claimed by appending modifier -22 (unusual procedural services) to 49020. Documentation must clearly support such a claim.