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Question: The surgeon performed a laparoscopic gallbladder removal for a 42-year-old patient. During the same session, the surgeon also performed an open repair of an incarcerated 4.2 cm spigelian hernia. Are we able to report two separate procedure codes for this?

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Answer: The usual incision locations for a laparoscopic cholecystectomy would differ from those used for a semilunar line repair of a spigelian hernia. As long as the medical documentation confirms separate incisions were made for the laparoscopic operation and the open hernia repair, it should be possible to assign codes for both procedures.

In this case, the appropriate codes would be 47562 (Laparoscopy, surgical; cholecystectomy) and 49594 (Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); 3 cm to 10 cm, incarcerated or strangulated).

Make note: The National Correct Coding Initiative (NCCI) bundles 49594 as a column 2 code to 47562. However, you may override the edit pair for different anatomic sites or incisions. Assuming the separate incisions or sites are in evidence in the op report, you could append modifier 59 (Distinct procedural service) or a similar modifier to 49594.

Remember: Due to the updates made to the hernia codes in CPT^庐 2023, which now groups together epigastric, incisional, ventral, umbilical, and spigelian hernias, it鈥檚 crucial to review the practitioner鈥檚 notes of the surgical sites to ascertain if procedures are or should be combined. For example, a repair of an umbilical hernia is more likely to be combined with a laparoscopic cholecystectomy, as most of these procedures typically utilize an umbilical incision.

Lindsey Bush, BA, MA, CPC, Development Editor, AAPC