Wiki Component Separation in Hernia Repair

[jackandjane]

Can anyone explain to me why its not ok to bill 15734 with hernia repair codes (exp 49560,49568, & 15734,15734-59). I have seen so much contradicting information. There is so much contradiction, use it dont use it. I cant seem to find any documentation that says why its inappropriate.

Any advice would be greatly appreciated.

 

[cynthiabrown]

I always used it.....try the american general surgeon website

 

[tcooper@nmhs.net]

I use code 15734 as the primary code because it has the higher RVU. Make sure that the component separation was done bilaterally and not just on one side. If it was done bilaterally you should use a 50 modifier if it is a Medicare patient. Mississippi Medicaid will only allow one unit of code 15734 so you might want to check with the carrier that you are billing to. I bill the codes as follows 15734, 49560-59, 49568-59 and have not had any problems with getting it paid. if it was a bilateral separation I would use 15734-50.
Hope this helps.
Teresa