Component Separation-with abdominal hernia

buppkl

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I am interested in any information you could share on billing a Component Separation with abdominal hernia w/ mesh repairs. I was given the code 15734 to bill bilaterally. When researching this code, I find that the bilateral indicator on the Medicare fee schedule is "0" inidicating it is not applicable. I was also told that you should not bill twice, as this procedure is reported for repair of a defect, not by the number of flaps used to close the defect. Getting alot of conflicting info and want to be certain on how this should be billed. If it can be billed twice I want to be sure to get the monies due us.
Any advice appreciated.:confused:
 

rjconnell

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Yes, there is a ton of conflicting information. The mesh reps in my area are saying to bill it a second time with a 59 since the code is not eligible for bilateral. NOT! I agree with only billing once. As you said MCR says not eligible for bilateral, go with MCR guidelines. Just my thoughts, all I have specifically in writing is from reps and I just don't agree with it.
 

Treetoad

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Where will these reps be if you're audited? And what difference will it make even if you've got them in your corner? I'd go with the Medicare guidelines.
 

rjconnell

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In my case I am using 15330 or 15430 for the mesh depending on the type. The 15734 is for creating the muscle flaps on the trunk.
 

aguelfi

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Mesh is included in the repair accept for open incisional or ventral repair. Then you would use 49568 to report. What information do you have that says otherwise? I'm wondering if I'm missing something.
 

rjconnell

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You are correct on the above. It is my understanding that Component Separation is much more extensive than a normal open hernia repair as it involves creating mucle flaps 15734.

As already stated there is much controversy on billing these. The position that my office takes is that using a "acellular dermal allograft" is not the same as "mesh". Others say that you cannot bill 15530 "acellular dermal allograft" for any reason other than skin replacement which was its original intent. The third option I have heard is to bill both 15530 & 49568. Personally I disagree with that, decide if you are calling it mesh or an implant, you should choose one or the other.

Just my thoughts.
 
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