General Surgery Coding Alert

Question: Which code should I use for the removal by laparotomy of an infected Marlex Dual Mesh placed during a previous hernia repair?

The surgeon also drained an intra-abdominal abscess and debrided the wound.

Texas Subscriber

Answer: Removal of the mesh is included in the abscess drainage. Therefore, you would only report 49020 (Drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess; open) to cover the entire procedure (the debridement is also part of the drainage).

Note that if the surgeon performs the drainage with mesh removal during the global period of the original hernia surgery, you should append modifier 78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period) to 49020.

Don't forget a diagnosis: One possible diagnosis for this encounter is 998.59 (Other postoperative infection; postoperative abscess, intra-abdominal, stitch, subphrenic, wound or septicemia). Be sure to check the patient's chart for specifics, however.