Surgical Coding: Heed These Hernia Bundling Rules

Did you factor in a foreign body removal code by any chance?

Question: During an open hernia repair for a reducible umbilical hernia, the surgeon detects a sizeable gallstone embedded in the omentum extending into the preperitoneal fat and he excises the gallstome granuloma with cautery. Patient history shows cholecystectomy eight years ago. So what are the right ICD-9 and CPT codes?

Answer: The right procedure code for this scenario is 49585 (Repair umbilical hernia, age 5 years or older; reducible). If the gallstone resection represents a significant amount of extra time and effort, modifier 22 would be apt.

Watch out: You shouldn't go for the omentum gallstone resection (49255, Omentectomy, epiploectomy, resection of omentum [separate procedure]) in addition to the 49585 hernia repair. As a designated ‘separate procedure' code, you should list only 49255 if it is the only procedure the surgeon carries out at the site. As you indicate that the gallstone is imbedded in the omentum and extends only partially into the peritoneum, you shouldn't code the service as a peritoneal foreign body removal (49402, Removal of peritoneal foreign body from peritoneal cavity).

As far as ICD-9 codes are concerned, the documentation can make a huge difference. If your surgeon points to the fact that he thinks the gallstone was dropped and left in the omentum during the previous surgery, you should think of it as a foreign body left during surgery and report 998.4 (Foreign body accidentally left during a procedure). Or else, the best diagnosis code is 568.9 (Unspecified disorder of peritoneum). Code the umbilical hernia as 553.1 (Umbilical hernia).