Surgical Coding Mysteries: The Case of the Separate Mesh

November 21, 2009

Beware Separate Mesh Removal

Question: The surgeon performed the following: Made 10 cm supraumbilical transverse incision with 15-blade scalpel carried down through subcutaneous tissue using Bovie. Used combination electrocautery and blunted dissection to isolate area of scar tissue on patient’s right side. Noted sutures from previous umbilical hernia repair and mesh from right-lower abdominal hernia repair.

Excised mesh and surrounding scar tissue to level of fascia using combination Bovie and blunt dissection. Closed with 30 Vicrylc and interrupted nylons. Can we bill separately for abdominal exploration (49000), mesh removal (+11008), and scar revision (13101) based on this operative note?

Answer: No, you should not code three separate procedures. You should report 22999 (Unlisted procedure, abdomen, musculoskeletal system) alone for the service described by this operative note.

Here’s why: You should not list +11008 (Removal of prosthetic material or mesh, abdominal wall for infection [e.g., for chronic or recurrent mesh infection or necrotizing soft tissue infection] [List separately in addition to code for primary procedure]) because there is no indication of a post-op infection or a more extensive debridement for necrotizing soft tissue infection.

Although you are correct that complex repair codes such as 13101 (Repair, complex, trunk; 2.6 cm to 7.5 cm) describe scar revision, you should not use that code in this case. The service you describe goes deeper than the skin, and the surgeon does not document the length of repair or closure in layers as required for complex repair codes.

You cannot bill 49000 (Exploratory laparotomy, exploratory deliotomy with or without biopsy[s] [separate procedure]) because the surgeon did notperform a laparotomy — he did not document entering the abdomen, only working to the fascia level. The correct service is a foreign body removal from the abdominal wall. Although there are a number of codes that describe foreign body removal, none describe foreign body removal on the abdominal wall, so you must use the unlisted code. For pricing, you could refer to codes 13101 and 11008 if your surgeon feels that correctly represents his effort.

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