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Urology Coding Alert

Reader Questions :

Pull Out Hernia Repair for Coding Purposes

Published on Wed Jun 17, 2009

Question: Can we bill for an inguinal hernia repair (CPT 49525 ) when the physician performs a retropubic radical prostatectomy (55845) during the same session, same incision? CMS guidelines state, "The CPT descriptor for some genitourinary procedures includes a hernia repair.

A HCPCS/CPT code for a hernia repair is not separately reportable unless the hernia repair is performed at a different site through a separate incision. In the latter case the hernia repair may be reported with modifier 59."

Colorado Subscriber

Answer: Yes. You can report 49525 (Repair inguinal hernia, sliding, any age) and 55845 (Prostatectomy, retropubic radical, with or without nerve sparing; with bilateral pelvic lymphadenectomy ...) when your urologist performs them together during the same surgical session.

The Correct Coding Initiative (CCI) and CPT do not bundle the two procedure codes, so you can bill them together at the same encounter.

Hint: Each procedure is for a different problem/diagnosis and, therefore, should be paid.

Payment explanation: The hernia repair will be the secondary surgical procedure and the payer will reduce your reimbursement on that procedure code to half of the global fee when you bill it with the radical prostatectomy.

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