General Surgery Coding Alert

Question: The patient had a hernia repair by another surgeon more than 90 days ago and now has infected mesh. Would we still report the removal of the mesh as a post-op complication from the initial surgery?


Louisiana Subscriber


Answer: Because the global period of the initial surgery has passed, you would not report a return to the operating room to remove the infected mesh as a complication of the original procedure. Instead, you should rely on a primary diagnosis of 996.60 (Infection and inflammatory reaction due to unspecified device, implant and graft).

Unfortunately, CPT does not include a code for removal of infected mesh only. Therefore, you-ll have to rely on 49999 (Unlisted procedure, abdomen, peritoneum and omentum). You will have to provide the payer with complete documentation to describe the procedure.

You would use this unlisted-procedure code only if there is no new hernia repair. If the surgeon performs a new hernia repair at the same time, the mesh removal is included in the primary procedure.

You should not report +11008 (Removal of prosthetic material or mesh, abdominal wall for necrotizing soft tissue infection [list separately in addition to code for primary procedure]) to describe removal of mesh. Code 11008 is an add-on code for use with 11004-11006 only. These codes describe extensive debridement performed on high-risk patients for conditions such as Fournier's gangrene (608.83).