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Hernia repair with laparoscopic sleeve gastrectomy

A

askeens

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Lexington, KY
NCCI edits indicates that a hernia repair procedure may be inclusive to a laparoscopic sleeve gastrectomy (gastric sleeve surgery) but has a 1 indicator. I have a surgeon that is adamant that we should add a 59 modifier to the hernia repair CPT code 43281 in order to bill it with the gastrectomy procedure CPT code 43775. I am not comfortable doing this for every single case her performs when the two are performed in the same surgical session. I am unable to locate specific Medicare payer guidelines other than the NCD policy 100.1. Our local MAC does not have a LCD that addresses this either.

I would appreciate others' insight if you have experience with coding for these services.
 
43281 is considered part of 43775 as routine. For it to be separate, documentation should show distinct, extensive dissection and a separate repair. Separate reimbursement requires clear documentation of a distinct, pre-planned repair of a large symptomatic paraesophageal hernia that goes significantly beyond the routine dissection and closure required by the primary sleeve gastrectomy. I had a CPT assistant article but can't find it any longer.
 
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