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Incarcerated Appendix Removed During Inguinal Hernia Repair
I have a pt who came for repair of incarcerated inguinal hernia. The approach was laparoscopic. Aright inguinal hernia was identified. It was found to be containing incarcerated appendix. Attempts to reduce the appendix were unsuccessful with shearing of the serosa. Using scissors with cautery the peritoneum was opened from the right anterior superior iliac spine to the median umbilical ligament. The contents were dissected off the inferior flap laterally and down to the pubic tubercle medially. The round ligament was dissected off the hernia sac and the hernia sac was reduced into the abdominal cavity. The appendix was densely scarred in and dissection around the appendix was done until the hernia sac was completely cleared but the appendix did break apart. So would I code the incarcerated inguinal hernia only or how would I capture the appendectomy?
Question:
I have a patient who came for repair of incarcerated inguinal hernia. The approach was laparoscopic. A right inguinal hernia was identified. It was found to be containing incarcerated appendix. Attempts to reduce the appendix were unsuccessful with shearing of the serosa. Using scissors with cautery, the peritoneum was opened from the right anterior superior iliac spine to the median umbilical ligament. The contents were dissected off the inferior flap laterally and down to the pubic tubercle medially. The round ligament was dissected off the hernia sac, and the hernia sac was reduced into the abdominal cavity. The appendix was densely scarred in and dissection around the appendix was done until the hernia sac was completely cleared but the appendix did break apart. So, would I code the incarcerated inguinal hernia only or how would I capture the appendectomy?
Answer:
Per CPT, excision and/or repair of strangulated organs or structures are reported in addition to the repair of the strangulated hernia. However, if the appendectomy was performed due to an iatrogenic injury, the treatment of an iatrogenic complication is not separately reportable. Be sure that your documentation is clear in making the distinction between the two scenarios.
*This response is based on the best information available as of 08/20/26.
Laparoscopic Male Sling
What is the CPT code for robotic-assisted laparoscopic male sling using an in situ vascularized peritoneal flap? Is CPT 51992 applicable or is this specific for female genital system?
Question:
What is the CPT code for robotic-assisted laparoscopic male sling using an in situ vascularized peritoneal flap? Is CPT 51992 applicable or is this specific for female genital system?
Answer:
CPT 51992 is not a gender-specific code; therefore, it can be reported for patients of any gender.
This is further supported by the CPT Knowledge Base response published on 4/8/2013 that recommends reporting CPT 51992 with prostatectomy CPT 55866.
*This response is based on the best information available as of 07/16/26.
eTEP Hernia Repairs
Our provider is doing hernia repairs with an ETep which was explained to me as a myofascial advancement. Is this separately billable or is it considered bundled to the hernia repair?
Question:
Our provider is doing hernia repairs with an eTEP which was explained to me as a myofascial advancement. Is this separately billable or is it considered bundled to the hernia repair?
Answer:
eTEP (extended or enhanced view totally extraperitoneal) describes the surgical approach utilized for the procedure. The coding for anterior abdominal hernia repair remains the same regardless of the approach performed. The appropriate repair code should be selected based on whether the hernia is initial or recurrent, as well as the total defect size.
*This response is based on the best information available as of 06/04/26.
Lipoma Question
If a surgeon excises a subcutaneous lipoma in the thigh and inadvertently violates the fascia, would the repair level be above the fascia or within the fascia for coding purposes?
Question:
If a surgeon excises a subcutaneous lipoma in the thigh and inadvertently violates the fascia, would the repair level be above the fascia or within the fascia for coding purposes?
Answer:
Great question. In this scenario, there would be no separate reporting for the repair. Excision of a subcutaneous lipoma of the thigh is coded using a procedure code from the 2xxxx series, and closure—whether above or at the fascia—is considered inherent to the excision and is not separately reported.
Thank you for reaching out to KZA!
*This response is based on the best information available as of 05/07/26.
Exploratory Laparotomy with Other Procedures
Can we code for an exploratory laparotomy if we then perform another procedure that we did not know was necessary prior to the laparotomy?
Question:
Can we code for an exploratory laparotomy if we then perform another procedure that we did not know was necessary prior to the laparotomy?
Answer:
No, exploratory laparotomy is always included in other definitive procedures.
*This response is based on the best information available as of 04/07/26.
E/M Leveling on a Recurrent Keloid
The patient has a recurrent keloid following surgical excision and is largely asymptomatic, with only occasional pruritus and burning. Does this fall under low or moderate medical decision making.
Question:
The patient has a recurrent keloid following surgical excision and is largely asymptomatic, with only occasional pruritus and burning. Does this fall under low or moderate medical decision making?
Answer:
Based on the condition alone, a recurrent keloid that is stable and only mildly symptomatic would generally meet Low MDM under the “Number and Complexity of Problems Addressed” element. However, the final MDM level cannot be determined without considering the other two MDM elements: data reviewed and the risk of treatment and management. If no data is reviewed and management is limited to observation, conservative measures, or a minor procedure with no risks the overall MDM would remain Low.
*This response is based on the best information available as of 03/05/26.
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