General Surgery Coding Alert

Question: I'm having an issue with an insurance company overpayment for a laparoscopic diaphragmatic hernia repair. We're billing 39599, but they're saying we should use 49659. Who is correct? Florida Subscriber Answer: CPT 2010 introduced two new codes for lap paraesophageal or diaphragmatic hernia repairs, so you should select the correct code from these, as of Jan. 1: • 43281 -- Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; without implantation of mesh • 43282 -- ... with implantation of mesh. Check the date: If you're talking about a past claim denial from prior to Jan. 1, you have several issues to consider to determine the correct code. First, you might remind the insurer that 49659 (Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy) refers to defects in the abdominal wall, but your surgeon repaired a defect in the diaphragm. Second, you should consider that CPT generally places codes in the digestive [...]