General Surgery Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: Our physician performed a hernia repair on one side and an exploration on the other, but found no hernia. Should we code a second hernia repair with modifier -52, or report an exploration code?

New York Subscriber


Answer: If a separate incision was made to explore the second side, the procedure should be billed a second time with modifier -RT (right side) or -LT (left side) as appropriate, followed by modifier -52 (reduced services), says Kathleen Mueller, RN, CPC, CCS-P, an independent general surgery coding and reimbursement specialist in Lenzburg, Ill. The code for the first side should also have either modifier -RT or -LT appended.

ICD-9 code V71.89 (observation for other specified condition not found) should be linked to the appropriate hernia procedure code, Mueller says, noting that this V code is a payable diagnosis.

An exploration code, such as 49000 (exploratory laparotomy, exploratory celiotomy with or without biopsy[s] [separate procedure]), should not be billed because the surgeon does not usually perform work within the peritoneum.