Urology Coding Alert

Question: When, if ever, can I separately report an umbilical hernia repair code (49585) during a Davinci robotic total prostatectomy?

Michigan Subscriber

Answer: When closing an open surgical operative wound and at the same time repairing a ventral hernia, the hernia repair becomes part of the closure and a separate charge for the hernia repair should not be made. This clearly and certainly would apply to open surgery. 

Caveat: When performing laparoscopic surgery and then at the same encounter also openly repairing a ventral hernia as you implied in mentioning code 49585 (Repair umbilical hernia, age 5 years or older; reducible), these procedures should be separately billable. The urologist is using a separate approaches: open for the hernia repair versus laparoscopic for the Davinci robotic total prostatectomy (55866, Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed). Therefore, you should report 55866 and 49585.

Additionally, if after an initial operative laparoscopic procedure, your urologist then repairs a ventral hernia laparoscopically (49652, Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia [includes mesh insertion, when performed]; reducible) you should also be able to bill for the laparoscopic hernia repair as well as the initial laparoscopic procedure. The reason for two laparoscopic procedures is that there are two distinct pathological entities both treated laparoscopically. Therefore, you should report 55866 and 49652.