CPT Code for Hernia: Take the Mess Out

Published: 04th June 2009
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Recurrent hernia repair usually requires mesh removal, unless the physician can document extraordinary effort. It's a common procedure, but you can only bill separately for the procedure in a minority of cases. Make sure you know what they are.

1. Claim Placement with Incisional/Ventral Hernia

You may report separate placement of mesh (+49568, Implantation of mesh or other prosthesis for incisional or ventral hernia repair) only when the surgeon repairs an incisional or ventral hernia.

The specifics CPT codes for hernia: You may report 49568 with 49560 (Repair initial incisional or ventra hernial; reducible), 49561 (... incarcerated or strangulated), 49565 (Repair recurrent incisional or ventra hernial; reducible) and 49566 (... incarcerated or strangulated) when the surgeon documents mesh placement during the hernia repair.

2. Skip Separate Placement Code for All Others

For any hernia repairs which include epigastric, umbilical, spigelian and inguinal hernia repairs (49570-49651) - you should not separately report 49568, regardless of whether the surgeon places mesh during the repair.

3. No Separate Payment for Removal and Repair

If the surgeon removes infected mesh placed during a previous hernia repair when making a recurrent hernia repair, you generally cannot code separately - or receive reimbursement- for the mesh removal.

Although you may be tempted to report an unlisted- procedure or foreign-body-removal code for mesh removal with recurrent repair, this is inappropriate.

Tip: When removing mesh requires truly extensive effort, you may be able to gain additional reimbursement by appending modifier 22 (Unusual procedural services) to the appropriate recurrent CPT code for code hernia repair.

Provide your payer the complete documentation to describe the procedure along with the correct CPT code for code hernia to ensure you get your reimbursement.

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