Lap Cholecystectomy & Hernia Repair

SADAMS1723

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I'm having trouble getting BlueCross to pay a Lap Cholecystectomy and Hernia Repair on the same claim. Can someone help me with the correct way to bill these two together?
 

CodingKing

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In many cases its not separately reportable: From the NCCI Manual.

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.

If it meets the criteria for separate reimbursement listed above, modifier on the hernia repair would be 59.
 
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