General Surgery Coding Alert

Question: If the surgeon performs a laparoscopic release and repair of an incarcerated internal hernia of the small intestine, should I bill an unlisted code such as 49659?

New York Subscriber

Answer: You should use an unlisted code, but the better choice is 44238 (Unlisted laparoscopy procedure, intestine [except rectum]) instead of 49659 (Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy). That's because the lap hernia codes (49650- 49659) describe laparoscopic repair of hernias in the abdominal wall. The situation you describe involves an internal hernia in the small intestine, and CPT does not provide a specific code for that service.

Option:If your surgeon performed an open release and repair of an incarcerated internal hernia of the small intestine, you would still use a code that involved the "intestines." Your choice for an open procedure would be 44050 (Reduction of volvulus, intussusception, internal hernia, by laparotomy).