Wiki Bochdalek Hernia

[ccallycat]

Hoping someone can help me with a Bochdalek Hernia repair. Pt is 72yrs old female. Preop dx Congenital Bochdalek hernia, Right hemidiaphragm. The physician performed Exploratory Rt thoracotomy and repair of Bochdalek hernia with mesh after resection of 4x5 cm mass (documented as either omentum or viseral fat protruding through defect in diaphragm).

Code 39503 is for Repair, neonatal diaphragmatic hernia. I cannot find any information regarding the appropriate code for when the patient is an adult. I cant use 39540 or 39541 because this was not a traumatic diaphragmatic hernia, My physician was leaning more towards 39561. Or do i go with unlisted procedure, diaphragm 39599?

Thank you!

 

[SharonCollachi]

Have you looked at the 49000-49999 section, particularly 49491-49999?

 

[ccallycat]

Hi, Thanks! I just checked that out and its saying its for preterm infants, my patient is in her 70's. Bochdalek is a type of congenital diaphragmatic hernia and its usually diagnosed in infants, and everything I've read up on adults is that its rare, but it happens (basically they've lived with it, misdiagnosed with other issues). I found a lot of case studies but no coding help. I think because its rare it doesn't have a specific code. I had even "googled" the info and was referred to code 43335 and i thought maybe it was close, but its paraesophageal, and i confirmed w/my provider that its not the same. The other codes in the 49000 area lead me to incisional and ventral. I also have access to supercoder and someone had asked about a 4 month old patient since technically not neonatal, and supercoder stated "regardless of the age, if the type of hernia is congenital, even if the repair happened during infancy the code can be assigned 39503 as there is no fitting code for this hernia repair". Which make me question, Is the code stating that its a hernia that happens in neonatal period and can be used at any age, or its a hernia that is repaired only during the neonatal period? So confusing!!

I think the appropriate code would be 39561.