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Gastroenterology Coding Alert

Reader Question, Reserve +49568 for Incisional, Ventral

Published on Mon Nov 16, 2009

Question: I am billing 49505 and +49568 together and some payers are paying and others are not. Medicare is paying. What can I do about the other payers that are following CPT's rules? Georgia Subscriber Answer: This is incorrect billing, even if you are getting paid by some payers. You should immediately stop billing 49505 and +49568 together. In fact, you should also refund the carriers that paid you for these codes together. Why? The hernia types don't match up. Add-on code +49568 (Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection [List separately in addition to code for the incisional or ventral hernia repair]) is for incisional and/or ventral hernia repairs only. Code 49505 (Repair initial inguinal hernia, age 5 years or older; reducible) describes a reducible hernia. Therefore, you should never be billing +49568 [...]
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