Camille Posted Thu 16th of May, 2019 10:52:51 AM
Procedure: Open repair of incarcerated umbilical hernia. Two incarcerated ventral hernias were found and also repaired. One mesh was placed to for all three defects. I find documentation that states only one ventral hernia can be reported due to same incision. Can I code for all three hernias (and the mesh) even though all thru the same incision? 49561, 49561-59, 49587? Thank you.
SuperCoder Answered Fri 17th of May, 2019 03:28:50 AM
Thank you for your question.
As per the above presented documentation, Medicare will pay for only one hernia repair per incision. If the surgeon believes the hernia repair was unusually complex and added significantly to the overall procedure, then modifier-22, “Increased Procedural Services,” can be appended to the hernia repair code. Documentation explaining the increased procedural services should be added to the claim.
You are advised to report only one CPT® code and append modifier-22, as appropriate.
Hope that helps!
Camille Posted Fri 17th of May, 2019 12:19:24 PM
Thanks very much! If these were repaired laparoscopically, would MC allow more than one hernia repair (if different types/sites)?
SuperCoder Answered Mon 20th of May, 2019 07:12:34 AM
Thank you for your additional query.
If the anatomical locations of the hernias are different and you can justify the medical necessity with the help of supporting documentation, then, you can report the codes with modifier-59.
Please make sure, you are reporting the codes basis rules, regulations and payer specific guidelines related to hernia repair in your locality.
Hope it helps!