There are many different hernia repair procedures, and using the correct CPT and diagnosis codes when billing for such services can be quite complicated for surgeons and their office staff. But once they understand the correct codes, practices can receive proper reimbursement.
For the surgeon, there is no conflict between the pre- and postoperative diagnoses and the procedure because a ventral hernia is defined as any hernia of the abdominal wall other than one that is femoral or inguinal hernia. Using this definition, the procedure qualifies as a ventral hernia, even though the documentation for both pre- and post-op diagnoses clearly states otherwise.
It would be very easy to code all abdominal hernia other than inguinal hernia or femoral hernia with ventral hernia codes, based on the clinical definition, but the codes need to be based solely on the documentation in the operative report.
Code inguinal hernia with modifiers: Without modifiers, the initial left inguinal hernia repair would be denied because initial repairs are normally bundled with recurrent repairs. Attaching the modifiers overrides the edit, however, and shows the procedures were performed on different sides. In most cases, the femoral hernia repair is bundled to the recurrent inguinal repair on the same side because the same piece of mesh used to repair the inguinal is usually placed on the femoral hernia as well. If a different piece of mesh is placed over the femoral, and the documentation clearly and specifically notes that this was done and provides medical necessity for it, the femoral repair can be separately billed and should be reimbursed.
When the general surgeon sees a patient in the office who has had previous abdominal surgery and appears to have a hernia around the area of the umbilicus, great care must be taken in obtaining precertification for any procedure that may follow – because it will affect how you code for inguinal hernia.