Wiki coding of umbilectomy with hernia repair

[mrolf]

Our surgeon did a umbilectomy and then a umbilical hernia was noted and was repaired. When billed 49250-umbilectomy and 49585-umbilical hernia repair, Medicare denied the 49250. Does anyone know how this should have been billed? There was no indication in the CPT that this is a bundled procedure. Thanks

 

[ashikbabu5@gmail.com]

When checking with CCI edits, it shows CPT 49250 is bundled into CPT 49585. so we can bill with CPT 49585 but a doubt arises as "when performing umbilectomy the complete umbilical cord is removed then what is the use of repairing umbilical hernia" ? - anyone help me that can we bill with CPT 49250 or not.

 

[thomas7331]

CPT code 49250 has a 'separate procedure' designation in CPT, so it is always incidental and bundled to another procedure in the same anatomical location and should never be billed in addition. Under NCCI, a modifier cannot be used to override this bundling.

 

[CodingKing]

NCCI Manual States:

If a hernia repair is performed at the site of an incision for an open or laparoscopic abdominal procedure, the hernia repair (e.g., CPT codes 49560-49566, 49652-49657) is not separately reportable. The hernia repair is separately reportable if it is performed at a site other than the incision and is medically reasonable and necessary. An incidental hernia repair is not medically reasonable and necessary and should not be reported separately.