Change in Biological Mesh for Hernia procedures since ICD-10

novamed1

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Hi all,

I'm trying to help a client who's a medical device manufacturer understand some strange data that they're now receiving since the changeover from ICD-9 to ICD-10. Before ICD-10, the majority of biological mesh usage in hernia procedures was for ventral/incisional hernias, but since the changeover it appears that the majority of usage is now being reported for umbilical procedures. Here's the data that we're seeing:

Hernia - VI
Oct 14 - Sept 15 - Avg Monthly Totals for Biologic Mesh - 845
Oct 15 - Mar 16 - Avg Monthly Totals = 265 (declining from 737 in Sept 15 to 524 in Oct 15 to 145 in Mar 16)

Hernia - Umbilical
Oct 14 - Sept 15 - Avg Monthly Totals for Biologic Mesh - 71
Oct 15 - Mar 16 - Avg Monthly Totals = 775 (increasing from 129 in Sept 15 to 338 in Oct 15 to 1,090 in Mar 16)

Does anyone have any thoughts about why this shift may have occurred in the coding? There's no reason to believe that the usage by procedure would have changed. Thanks!
 
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I don't know if this has any impact, but the use of mesh is included in the hernia repair codes and is not reported separately (except for codes 49560-49566, incisional hernia repairs). If a charge goes out for an umbilical repair, it includes the use of mesh, whether it's actually used or not. I don't know how the data is being captured in your case, but if the reporting is capturing each umbilical repair charge going out, that would also count the use of mesh given that the mesh is inherent in the description of the codes.

Using 49587 Repair umbilical hernia, age 5 years or older; incarcerated or strangulated as an example;
The reporting software is programmed to capture code 49587 and interpret it as an umbilical repair. It has also been separately programmed to capture code 49587 and interpret it as use of mesh. Then what you end up with is an increase in the use of mesh, because the programming is reporting the use of mesh every time that code is captured (even though mesh may not have been used)
versus
49561 Repair initial incisional or ventral hernia; incarcerated or strangulated
The software captures code 49561 and interprets it as an incisional/ventral repair. But, because mesh is not included, there is not that separately programmed capturing of mesh with code 49561.
Instead, the system captures code 49568 and interprets it as use of mesh. Because 49568 is not always reported with 49561, you end up with an accurate reporting of when mesh is indeed used as CPT guidelines allow for separate billing.

My point being, if the system is designed like this, the data will be skewed for umbilical use of mesh because the code is all inclusive of both repair and mesh. There really would be no way to accurately capture the use of mesh in this case because it can't be reported separately.
 
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