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CCI Edit for 49652 and 49653

Stephanie Posted Tue 08th of October, 2019 17:26:09 PM
When I check to see if I can bill 49653 and 49652 together there's a CCI edit that indicates the 49652 is mutually inclusive to 49653. Can you please help me to understand why I can not bill 49653 for the incarcerated ventral hernia and 49652 for the umbilical hernia?
SuperCoder Answered Wed 09th of October, 2019 04:43:30 AM



As per NCCI edits, if a hernia repair is performed at the site of an incision for an open or laparoscopic abdominal procedure, the hernia repair (e.g., CPT codes 49560-49566, 49652-49657) is not separately reportable. The hernia repair is separately reportable if it is performed at a site other than the incision and is medically reasonable and necessary. An incidental hernia repair is not medically reasonable and necessary and shall not be reported separately.

CPT 49653 is more complex procedure than 49652 and the anatomical site for both hernias are also same. If physician performed procedure for incarcerated ventral hernia and umbilical hernia in same session, than only incarcerated ventral hernia repair code will be reported and umbilical hernia repair will be consider an integral part of 49653 (incarcerated ventral hernia repair).


As per CCI edits, CPT 49653 and 49652 have a modifier indicator of "0". A "0" indicator means that you may not unbundle the edit combination under any circumstances, according to CCI guidelines. 


Hope this helps!



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