General Surgery Coding Alert

Question: A patient had a right inguinal incarcerated hernia. When the doctor dissected the hernia sac, he noticed some ischemic bowel. The doctor documents in the op report "careful dissection of this down to a knuckle of bowel, which was ischemic." Is this incidental to the hernia repair or can I code for the partial small-bowel resection? If not, can I add modifier 22 to the hernia repair for the extra work involved? Missouri SubscriberAnswer: You should actually code the bowel resection instead of the hernia repair in this case. Therefore, you would report a code such as 44120 (Enterectomy, resection of small intestine; single resection and anastomosis) for an open approach or 44202 (Laparoscopy, surgical; enterectomy, resection of small intestine, single resection and anastomosis) for a laparoscopic approach. Your primary diagnosis code will most likely be ischemic bowel disease (557.x).Skip the hernia repair code and leave codes such as [...]