General Surgery Coding Alert

Question: Does CPT have a specific code for a laparoscopic release and repair of an incarcerated internal hernia of the small intestine, or should we bill an unlisted code such as 49659? How would we report the same service as an open procedure?

Illinois Subscriber

Answer: You will have to use an unlisted code because CPT does not provide a specific code for lap release and repair of an internal hernia in the small intestine. But you should report 44238 (Unlisted laparoscopy procedure, intestine [except rectum]) instead of 49659 (Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy).

Here's why: 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. Code 44238 describes an unlisted lap procedure involving the intestine, which is what you have.

Find open code: You also asked how to code an open release and repair of an incarcerated internal hernia of the small intestine. You should stay in the "intestines" CPT section to find the correct code for the open procedure. Based on the information you've provided, the best code would be 44050 (Reduction of volvulus, intussusception, internal hernia, by laparotomy).