General Surgery Coding Alert

Question: The surgeon performed a laparoscopic gallbladder removal for a 37 year old female patient. During the same session, the surgeon also performed an open repair of an incarcerated 2.5 inch spigelian hernia. Can we report two procedure codes for this?

Wisconsin Subscriber

Answer: The typical incision sites for a laparoscopic cholecystectomy would be distinct from the semilunar line repair of a spigelian hernia. Assuming documentation of different incisions for the laparoscopic procedure and the open hernia repair, you should be able to code both procedures.

The appropriate codes would be 47562 (Laparoscopy, surgical; cholecystectomy) and 49592 (Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); less than 3 cm, incarcerated or strangulated).

Caution: The National Correct Coding Initiative (NCCI) bundles 49592 as a Column 2 code to 47562. However, you may override the edit pair for different anatomic sites or incisions. Assuming the separate incisions or sites are in evidence in the op report, you could append modifier 59 (Distinct procedural service) or similar modifier to 49592.

Notice: Because CPT^® 2023 changed the hernia codes in a manner that lumps together epigastric, incisional, ventral, umbilical, and spigelian hernias, you need to carefully assess the surgical sites to determine if procedures are bundled. For instance, an umbilical hernia repair is more likely to be bundled with a laparoscopic cholecystectomy, because most of those procedures use an umbilical incision for the procedure.