General Surgery Coding Alert

Question: When billing multiple surgeries, such as a laparoscopic cholecystectomy and hernia repair, if the patient is seen in the office and scheduled to have both in the same operative setting, can we bill both procedures with modifier 59 showing that they are separate procedures/separate organs?

North Carolina Subscriber

Answer: The answer depends on whether the laparoscopic cholecystectomy and the hernia repair are at different sites.

Just because the surgeon schedules both procedures in advance and they are “separate procedures” doesn’t warrant separate billing. If you document that the procedures are at different anatomic sites (separate incisions), you can bill them separately.

Here’s why: The 2020 NCCI Policy Manual Chapter 6 section E (VI-9 E) states, “If a hernia repair is performed at the site of an incision for an open or laparoscopic abdominal procedure, the hernia repair (e.g., CPT^® codes 49560-49566, 49652-49657) is not separately reportable. The hernia repair is separately reportable if it is performed at a site other than the incision and is medically reasonable and necessary.”

If the surgeon documents that the lap chole and the lap hernia repair are at different sites (incisions), you can bill 47562 (Laparoscopy, surgical; cholecystectomy) plus the appropriate code for the incisional hernia repair, such as 49654 (Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); reducible). Append the appropriate modifier, such as 59 (Distinct procedural service) or XS (Separate organ/structure), to the hernia repair code.