Q: (Coding Hernias) – This is the one I was suppose to answer.
“What are the steps in coding hernias?
I missed this on a test question.”
A: So, we got someone preparing for their CPC board exam.
What I did is I pulled up my CPT manual and I do a method called “bubbling and highlighting.”If
you’re not familiar with it, I think I still have it up when we bring it in to view here.
And this is my CPT manual, and in December when I did my Blitz broadcast at Boy’s studio,
this was the star of the show, the CPT manual with all the notes on it.
Looks a little messy but the concept is to group like codes together; it’s typically
apparent code with the indented codes in any parenthetical notes with it.
So, the hernia codes are in the digestive system toward the end and the guidelines are
all up here in the top.
So, the question wants to know: What do I need to pull out of the report to help me
to get the correct code?
And so, what we typically do in our class is we try and give you – like up here where
I have number 1, age.
You want to pull that out of the report.
Initial versus recurrent – you want to abstract that from the report.
Is it reducible or not?
And I’ll talk about that in a second, and location – where is it?
So that’s what I have on the answer sheet.
Here are those variables, location, or type.
So, location could be inguinal, lumbar, you know the different areas that way.
Initial or recurrent, if a physician is repairing hernia that keeps coming back; then, the recurrent
ones are going to be worth more money.
The RVU is going to be higher.
But if they don’t state it; then, we assume initial because that’s the lower RVU value
one.
So, there’re only a few instances as coders we’re allowed to assume anything about the
medical record, this is one of them.
We need to know the age of the patient, and whether or not the hernia is reducible.
Now, this one really bugged me in the beginning as a coder because “reduce” you think
make smaller but it actually just means popping it back into alignment.
If someone breaks her nose and the doctor refractures it, it’s reducing the fracture,
they’re putting back in normal alignment.
So, you see how the grouping helps you visually, really quickly do process of elimination to
drill down to the correct codes.
And this isn’t just for board exams, it’s very helpful for real-world coding because
it
really helps you do that process of elimination quickly.
As much as I love using digital devices and encoders, sometimes I like to go to my manual
to see it in context and see the bubbles next to each other.
Here we’ve got the 49560 and 565 bubble; these are the incisional ones that I was talking
about, or recurrent.
This is initial recurrent, this is of the ventral, so now I’ve got these stars and
going down to this parenthetical note: With the exception of the incisional hernia repairs,
49560-49566, so the two bubbles above.
The use of mesh or other prostheses is not separately reported.
So, here’s our guideline, it can be reported with these two but everything else it’s
bundled.
So if you have a physician that’s really questioning it, show him right in the CPT
manual which is from his/her AMA association.
Once you realize you use it, here’s the add-on code, 49568 – Implantation of mesh
or other prosthesis for open incisional or ventral hernia repair or mesh for closure
debridement for necrotizing soft tissue infection, etc.
So, that’s the mesh one.
Then, it just goes on, repair of epigastric reducible or incarcerated.
We’ve got umbilical, then we have age.
What I’ll do in my bubbles is I’ll put little notes in there, like, the age notes,
the things that I want to jump out at me to help me make a decision for process of elimination.
The spigelian or the omphalocele, those are on their own.
Here’s two more omphalocele bubbles, this one is large, with our without prosthesis,
removal of prosthesis, and then that’s it.
Those are all the hernia repairs.
They do go into some scope-type repairs.
I could probably add that as another top variable: is it a scope repair versus open?
More and more since I started teaching this, I think there’s only one scope code, and
now we’ve got four bubbles now, so the ability to do scope repairs for hernia has increased.
Hopefully, that will help the questionnaire on understanding how to code hernias.