Don't have a TCI SuperCoder account yet? Become a Member >>

Regular Price: $24.95

Ask An Expert Starting at $24.95

Have a medical coding or compliance question? Don’t sacrifice your valuable time to endless research. Choose Ask an Expert to get clear answers from the TCI SuperCoder team. And here’s a tip for the budget-conscious: Select the 12-question pack to get the best rate per question!

Browse Past Questions By Specialty

+View all

Multiple Hernias Same Incision

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

Hello Camille,

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!

Thanks

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

Hello Camille,

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!

Thanks

Related Topics