General Surgery Coding Alert

Question: Patient was scheduled for open umbilical hernia repair, but fistula tract was also excised. Based on the following excerpt from the op report, should we bill 49585 or 51500?

"Umbilicus detached from the umbilical hernia. Excised and removed fistula tract, umbilicus to urachal remnant. Partial omentectomy ligated and reduced back into abdomen. Mesh repair of fascial defect. Opening in umbilicus closed with 4-0 Vicryl."

California Subscriber

Answer: The correct code for the procedure you describe is 49585 (Repair umbilical hernia, age 5 years or older; reducible). Code 51500 (Excision of urachal cyst or sinus, with or without umbilical hernia repair) describes a more extensive procedure involving removal of a urachal cyst. Your documentation describes excision of a fistula between the umbilicus and the urachal remnant, not a urachal cyst or sinus.

If the surgeon documents that the fistula excision adds significant work to the hernia repair, you can append modifier 22 (Increased procedural services) to 49585.