How To Use CPT Code 39503

CPT 39503 describes the surgical repair of a hernia of the diaphragm in a newborn child. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 39503?

CPT 39503 can be used to describe the surgical repair of a hernia of the diaphragm in a newborn child. This code is used when the provider performs the repair, with or without chest tube insertion, and with or without creation of a ventral hernia.

2. Official Description

The official description of CPT code 39503 is: ‘Repair, neonatal diaphragmatic hernia, with or without chest tube insertion and with or without creation of ventral hernia.’

3. Procedure

1. The provider prepares and anesthetizes the patient.
2. An incision is made in the abdomen.
3. The hernia sac is excised and removed.
4. The herniated organs are repositioned in the abdomen.
5. The hole in the diaphragm is closed with stitches or a mesh graft.
6. A drain may be placed, and the incision is closed with sutures.

4. Qualifying circumstances

Patients eligible to receive CPT 39503 services are newborns with a hernia of the diaphragm. The procedure may involve the insertion of a chest tube and the creation of a ventral hernia. The provider must assess the patient’s condition and determine the need for surgical repair.

5. When to use CPT code 39503

CPT code 39503 should be used when a provider performs the surgical repair of a hernia of the diaphragm in a newborn child. This code should be used regardless of whether a chest tube is inserted or a ventral hernia is created during the procedure.

6. Documentation requirements

To support a claim for CPT 39503, the provider must document the following information:

• Patient’s diagnosis of a hernia of the diaphragm
• Details of the surgical repair, including whether a chest tube was inserted and if a ventral hernia was created
• Date of the procedure
• Specific steps taken during the procedure
• Any complications or additional procedures performed
• Signature of the provider

7. Billing guidelines

When billing for CPT 39503, ensure that the procedure meets the criteria for this code. Report modifier 63 only if instructed to do so. Be aware of any Medicare changes that may affect billing for this code. Do not report CPT 39503 in conjunction with modifier 63.

8. Historical information

CPT 39503 was added to the Current Procedural Terminology system on January 1, 1990. It was later added to the Inpatient Only (IPO) list for Medicare in 2017.

9. Examples

1. A provider surgically repairs a hernia of the diaphragm in a newborn child, without chest tube insertion or creation of a ventral hernia.
2. A provider performs the repair of a hernia of the diaphragm in a newborn child, with chest tube insertion and creation of a ventral hernia.
3. A provider surgically repairs a hernia of the diaphragm in a newborn child, with chest tube insertion but without creation of a ventral hernia.
4. A provider performs the repair of a hernia of the diaphragm in a newborn child, without chest tube insertion but with creation of a ventral hernia.
5. A provider surgically repairs a hernia of the diaphragm in a newborn child, with chest tube insertion and creation of a ventral hernia, using a mesh graft.
6. A provider performs the repair of a hernia of the diaphragm in a newborn child, without chest tube insertion or creation of a ventral hernia, using diaphragmatic plication.
7. A provider surgically repairs a hernia of the diaphragm in a newborn child, with chest tube insertion but without creation of a ventral hernia, using diaphragmatic plication.
8. A provider performs the repair of a hernia of the diaphragm in a newborn child, without chest tube insertion but with creation of a ventral hernia, using diaphragmatic plication.
9. A provider surgically repairs a hernia of the diaphragm in a newborn child, with chest tube insertion and creation of a ventral hernia, using diaphragmatic plication and thoracotomy.
10. A provider performs the repair of a hernia of the diaphragm in a newborn child, without chest tube insertion or creation of a ventral hernia, using diaphragmatic plication and thoracotomy.