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billing for open and lap hernias

Naomi Posted Wed 13th of May, 2020 17:43:38 PM
How would you code for an open incisional hernia repair and a laparoscopic umbilical repair that were done during the same SX on different sides? This particular claim was coded as 49560, 49652-xs, and 43568-xs, but 49652-xs was denied as another procedure was done the same day.
SuperCoder Answered Thu 14th of May, 2020 04:07:02 AM

Hi Naomi,

 

Thanks for your question.

 

There is CCI edit between codes 49560 and 49652 and code 49652 is a column 2 code for 49560. These codes cannot be unbundled in any circumstances. This is why payer has denied code 49652, which is correct. This cannot be paid.

 

Our suggestion is that you may report code 49650 (Laparoscopy, surgical; repair initial inguinal hernia) instead of 49652. This may be paid and in this way, your doctor may get additional $451 approx.

 

Please feel free to write if you have any question.

 

Thanks.

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