General Surgery Coding Alert

Question: During a laparoscopic procedure investigating a bulge in the patient’s upper inner thigh, the surgeon identified a femoral hernia containing fatty tissue and reduced the hernia. Should we bill the hernia repair as 49550? Could we use modifier 22 because of the exploratory laparotomy?

Oregon Subscriber

Answer: No, you should not bill the hernia repair using 49550 (Repair initial femoral hernia, any age reducible), because that code describes an open hernia repair procedure.

CPT^® does not include a code for laparoscopic femoral hernia repair, so your only choice would be 49659 (Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy).

Nor should you use modifier 22 (Increased procedural services) in this case. Appending the modifier to 49550 would be inappropriate because the service you describe is not an open procedure that takes additional work. Instead, it is a completely different procedure.

You also should not use modifier 22 with 49659, because unlisted codes don’t match any fixed, described procedure. Using 22 in that case would suggest that you did something extraneous beyond a specific, defined procedure.

Do this: When using an unlisted procedure code, you must provide clear and detailed documentation describing the procedure or service performed. This may include a comprehensive summary of the intervention, the rationale for its use, the equipment or materials involved, and any complications or specific circumstances surrounding the case.

Key: Use an unlisted procedure code only when no existing code accurately reflects the specific service or treatment provided. The use of unlisted codes may require additional approval from insurance companies or other payers, and there could be challenges in obtaining reimbursement for these services.