Wiki Complex Hernia Surgery - Coding Help

[kathiepa]

I'm hoping to get some assistance with the below surgery. It was a MVA and the claim was billed as 49653-22, but we were not paid more. I'm questioning on if we could have billed another code, etc.

Procedure: Robotic-Assisted reduction and repair of complex incarcerated traumatic left upper quadrant abdominal hernia with mesh, difficulty(over 4 hours, twice normal operating time due to adhesions and incarceration)

5 x 2 x 2 inch incarcerated non-strangulated complex left upper quadrant flank traumatic hernia containing colon and spleen and omentum.

Description of procedure: SEE ATTACHED OPERATIVE NOTE

 

[thomas7331]

The CPT code looks OK to me, but you may want to consider adding HCPCS code S2900 for the use of the robotic system if the payer will accept that code.

Modifier 22 often does not result in an automatic payment increase unless you submit supporting documentation and specifically request it - did you submit the operative report with the claim and request an additional payment? If not, I would recommended appealing the payment with a copy of the report and a letter stating what you think the proper payment would be based on the extra work that was documented.