General Surgery Coding Alert

Question: How should I code laparoscopic repair of a ventral hernia (initial or recurrent) with placement of mesh prosthesis?

Illinois Subscriber  
Answer: Implantation of mesh should be billed only with an open ventral or incisional hernia, either initial or recurrent, says Elaine Elliott, CPC, an independent general surgery coding and reimbursement specialist in Jensen Beach, Fla. According to CPT, the code for mesh implantation, 49568 (implantation of mesh or other prosthesis for incisional or ventral hernia repair [list separately in addition to code for the incisional or ventral hernia repair]), is an add-on code that may be used only with 49560 (repair initial incisional or ventral hernia; reducible), 49561 ( incarcerated or strangulated), 49565 (repair recurrent incisional or ventral hernia; reducible) and 49566 ( incarcerated or strangulated).
 
Mesh implantation should not be billed if laparoscopic hernia repair was performed. Mesh is always placed during laparoscopic hernia repairs and is therefore included in the repair.