Camille Posted Thu 16th of May, 2019 21:34:25 PM
Per the Medicare CCI Manuel, "if a hernia repair is performed at the site of an incision for an open or laparoscopic abdominal procedure, the hernia repair is not separately reportable." Can i bill an open or laparoscopic umbilical hernia that was preoperatively diagnosed, where the surgeon chooses to place a port (trocar incision) thru the umbilical defect-then performs the abdominal surgery and repairs the umbilical hernia. Why don't Umbilical Hernia codes come back with an edit when i run them against other laparoscopic abdominal procedure codes in the CCI Edit Checker? Thank you.
SuperCoder Answered Fri 17th of May, 2019 07:54:35 AM
Thanks for your question.
It is appropriate that if a hernia repair is performed at the site of an incision for an open or laparoscopic abdominal procedure, the hernia repair is not separately reportable.
Please provide procedures codes that you have coded for the above mentioned procedures, so that we would be able to give appropriate answer.
Camille Posted Fri 17th of May, 2019 13:40:35 PM
Pre-op dx: K40.20 and K42.0 Performed 49650-50 and 49653. Both the Umbilical & Inguinal hernias were planned. Occasionally the procedure is described that the surgeon chooses to go thru the umbilical hernia defect (knowing of its existence) and i still would like to bill for this because it was a planned procedure, not incidental. Is that appropriate? Also, please correct me if I'm wrong: if surgeon does not document entering the umbilical defect with the port incision, i believe the laparoscopic umbilical hernia is billable-even though there is an incision in the area of the umbilicus.
SuperCoder Answered Mon 20th of May, 2019 10:36:29 AM
Thanks for the information.
As per the above documentation since both the procedure of umblical and inguinal hernias were planned then they can be billed together based on the medical necessity. However, to provide the information that the procedures are distinct then modiifier 59 can be billed. It is suggested that modifier 59 can be billed with lower RVU value code to avoid denial or better reimbursement. Also, please check with your payer guidelines regarding the same. It is appropriate that if a hernia repair is performed at the site of an incision for an open or laparoscopic abdominal procedure, the hernia repair is not separately reportable.
Hope this helps.