General Surgery Coding Alert

Question: I’m reviewing a coder’s work for a surgery case for a ventral hernia (reducible) lap repair converted to open, requiring mesh implantation. The coder is listing 49565, 49568 and 49656-74. Is this correct?

Washington Subscriber

Answer: When a surgeon converts a laparoscopic procedure to open, you should code only the open procedure.

Your coder claims the following:

49565 -- Repair recurrent incisional or ventral hernia; reducible

49568 -- Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair)

49656-52 -- Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); reducible (Reduced services).

Instead, you should code the case as 49565 and 49568. If the surgeon documents that he performs significant additional work and spends extended time on the procedure because of the conversion, you can append modifier 22 (Increased procedural services) to 49565.

Dx can help: You might want to add V64.41 (Laparoscopic surgical procedure converted to open procedure) to your report to document the conversion from lap to open.