Monday, August 26, 2019

Coding Hernia Repairs in ICD-10-PCS

The previous installment of “In the kNOW”  presented information on hernia diagnosis coding.  Now our attention is going to turn to appropriately hernia repairs.  Let’s start with a basic piece of information which has been provided in Coding Clinic which states that when a hernia is manually reduced it is not separately reported.  So no code assigned for a manual hernia reduction.   

Hiatal hernias can be repaired either through an open or percutaneous endoscopic approach.  Additionally, a determination will have to be made on the correct root operation to assign.  Was it a repair only, in which case the root operation is Repair, or was it with the use of mesh or other augmentative agent, in which case the root operation would be Supplement.

Hiatal hernias repaired through a percutaneous endoscopic approach with mesh = 0BUT4JZ

Hiatal hernias repaired through a percutaneous endoscopic approach without supplement = 0BQT4ZZ

Inguinal hernia repairs have similar determinations that must be made:  Open or Percutaneous endoscopic approach; Repair or Supplement root operation.  If it is a Supplement, what type of material: autologous, non-autologous, or synthetic substitute?  A coding professional will also have to distinguish whether the procedure was done on the left side, right side, or bilaterally.

Inguinal hernia repaired via an open approach with mesh = 0YU60JZ

Inguinal hernia repaired via an open approach without supplement = 0YQ60ZZ

Parastomal hernias are a type of incisional hernia occurring at the site of an ostomy.  These can be repaired either with an open or laparoscopic approach.

Parastomal hernia repair with an open approach = 0WQF0ZZ

Internal hernias are seen in patients who have undergone bariatric surgery.  Those who have bariatric procedures performed laparoscopically have a greater incidence of internal hernias often located in Petersen’s space.  That is an area between the mesentery and the transverse colon.  The primary consideration regarding this type of hernia repair is whether it was done with an open or laparoscopic approach.  It is important to keep in mind that the hernia defect is in the mesentery so that is the correct body part that should be coded.

Internal hernia repair done laparoscopically = 0DQV4ZZ

In ICD-10-PCS, incisional, ventral, and umbilical hernia repairs are all coded to repair of the abdominal wall.  Approach and root operation determinations are critical to assigning the correct code for these repairs as with the others we have already discussed.

Repair, abdominal wall, open approach = 0WQF0ZZ

Occasionally, for patients who have already had an incisional hernia repair, a second repair becomes necessary.  A surgeon may perform an abdominal component release.  This procedure separates the layers of the abdomen (components) in order to primarily close the hernia.  This is done with what are called relaxing incisions, which effectively free the abdominal muscle making that the body part for the root operation Release.  It is not uncommon to see the use of mesh in this procedure as the now single layer abdominal area will be weakened. 

Right abdominal component separation = 0KNK0ZZ

Ventral hernia repairs may require an abdominoplasty along with plication.  If dermal and fat layers are removed, coding professionals should be sure to code the root operation Excision for the abdominal subcutaneous tissue and fascia taken out, in addition to the root operation Repair for the plication of the abdominal wall.

Questions have arisen regarding the appropriateness of assigning an additional code(s) for lysis of adhesions during hernia surgery.  The official advice provided indicates that should the lysis of adhesions go beyond what must be done to get to the operative site then the lysis can be separately coded.  Apply the root operation Release and assign the code(s) for the body part that is freed. 
Now you are In the kNOW!!

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.

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