General Surgery Coding Alert

Question: During an open hernia repair for a reducible umbilical hernia, the surgeon finds a sizeable gallstone embedded in the omentum extending into the preperitoneal fat. The surgeon excises the gallstone granuloma with cautery. Patient history indicates cholecystectomy eight years ago. What are the correct ICD-9 and CPT codes? Utah Subscriber Answer: The proper procedure code for this scenario is 49585 (Repair umbilical hernia, age 5 years or older; reducible). If the gallstone resection represents a significant amount of extra time and effort, modifier 22 (Increased procedural services) would be appropriate. Watch out: You should not report the omentum gallstone resection (49255, Omentectomy, epiploectomy, resection of omentum [separate procedure]) in addition to the 49585 hernia repair. As a designated "separate procedure" code, you should only list 49255 if it is the only procedure the surgeon performs at the site. Because you indicate that the gallstone is imbedded in the omentum and [...]