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Component separation in hernia repairs
ldolyak
New
What code would you use if you did not use the alloderm
component separation
Recently we were audited by a major payer for these procedures. They are really not a 15734 however very close. After much deliberation with our physicians and the physicians at the insurance company an agreement was made that the most appropriate billing would be as an unlisted abdominal procedure 49999 with a fee close the 15734. In addition to the 49999 you should also bill for the hernia repair when done as well as the implementation of the mesh. Even more recently this payer did a local seminar as a result of our collaboration on these procedures.
Recently we were audited by a major payer for these procedures. They are really not a 15734 however very close. After much deliberation with our physicians and the physicians at the insurance company an agreement was made that the most appropriate billing would be as an unlisted abdominal procedure 49999 with a fee close the 15734. In addition to the 49999 you should also bill for the hernia repair when done as well as the implementation of the mesh. Even more recently this payer did a local seminar as a result of our collaboration on these procedures.
Compartment Separation W/incision Hernia
We were instructed by the mesh producers and representatives that CPT 15734 is the code to use for compartment separation. We received payment by Unicare for our first procedural service performed in 2008 for bilateral procedure when done in conjunction with incisional hernia repair w/mesh - no denials - payment on first presentation of claim. This causes us some concern. I would like to hear from other CPCs about this issue.
We were instructed by the mesh producers and representatives that CPT 15734 is the code to use for compartment separation. We received payment by Unicare for our first procedural service performed in 2008 for bilateral procedure when done in conjunction with incisional hernia repair w/mesh - no denials - payment on first presentation of claim. This causes us some concern. I would like to hear from other CPCs about this issue.
emeskina
Networker
There's more...
I've got two sources that contradict those statements. The PDF is too large to attached, but I'd be happy to fax it to you. You can reach me by e-mail ; eeskina@upamed.org
Erin Eskina, CPC
Truman Medical Centers/UPA
KC MO
I've got two sources that contradict those statements. The PDF is too large to attached, but I'd be happy to fax it to you. You can reach me by e-mail ; eeskina@upamed.org
Erin Eskina, CPC
Truman Medical Centers/UPA
KC MO
sgochoco
Networker
SGochoco
I would be very wary of taking advice or recommendations from the "mesh producer". They are in the business of selling their product, so they are only too happy to recommend a cpt code for the procedure. They have a different agenda than we Coders do. Even though it is billed as you say, and paid, that does not mean that it was coded correctly. We bill this procedure with an unlisted procedure code, in addition to the hernia and mesh if appropriate. We feel that our method is defendible in an audit.
SG
I would be very wary of taking advice or recommendations from the "mesh producer". They are in the business of selling their product, so they are only too happy to recommend a cpt code for the procedure. They have a different agenda than we Coders do. Even though it is billed as you say, and paid, that does not mean that it was coded correctly. We bill this procedure with an unlisted procedure code, in addition to the hernia and mesh if appropriate. We feel that our method is defendible in an audit.
SG
Our practice is also now visiting this scenario and we agree that the 15734 is not a 100% code, so therefore, should not be used. For our surgeons we are going to go with the 49999 as recommended here as well. We also have another component to this. Our provider has used Veritas bovine pericardium mesh as well. We are wondering if the add-on code 49568 provides accurate reimbursement for this. Some of our providers use Alloderm, which we use an unlisted code for this as recommended by the AMA through the General Surgery Coding Alert publication. Any thoughts if we should go the same route with the Veritas "mesh". We currently are using the 49568 add-on code.
One more question too... if basing the unlisted on the 15734 as a comparison, the RVUs for the incisional/ventral hernia repairs are less than the 15734 RVUs. So, would you code the 49999 as the primary procedure and get stuck with what ever the payer reimburses for unlisted codes or still post the hernia as the primary with the unlisted component separation as a secondary code?
One more question too... if basing the unlisted on the 15734 as a comparison, the RVUs for the incisional/ventral hernia repairs are less than the 15734 RVUs. So, would you code the 49999 as the primary procedure and get stuck with what ever the payer reimburses for unlisted codes or still post the hernia as the primary with the unlisted component separation as a secondary code?
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