CPT 15777 is new add on code for implantation biologic mesh for soft tissue reinforcement (e.g. breast, trunk). Can this now be used for major surgeries such as partial colectomy, low anterior resection, small bowel resection, etc when the physician uses a biologic mesh to reinforse closure? I have always been under the impression that with the past deleted skin codes this was considered bundled/inclusive. Any thoughts?
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Wiki New Mesh add on CPT 15777
- Thread starter acbarnes
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cmartin
Guru
just on a quick search of the tables on the NCCI cd for Jany-March 2012, it doesn't appear to be bundled to any of those codes. (and it is to some others)
SJensen
I have found Medicare refuses to pay this code stating it can only be used with certain qualifing services and yet no one at Medicare can tell me what those are. I have used it with colectomies and colostomy takedowns. Other insurances have paid fine. Any suggestions.
I have found Medicare refuses to pay this code stating it can only be used with certain qualifing services and yet no one at Medicare can tell me what those are. I have used it with colectomies and colostomy takedowns. Other insurances have paid fine. Any suggestions.
Since my orginal posted I have spoken with a few national coders. The concenus is that no really knows yet. NCCI allows the new code to be billed with alot of the colectomy codes. However, as we know in the past most colectomies include complex closures which had included mesh in the past. You are certainly able to bill it at this time; however, as ins companies/Medicare/Medicaid develop their policies it may become bundled once again. If it is passing the insurance company edits then can bill it. My practice has decided not to bill it at this time since I could not support a seperate procedure appeal as the use of mesh is a common practice in the surgeries and it is not really "above and beyond." I am cautious and will wait for more information. I do not know that this answer really helps......
syllingk
Guest
I have had a mesh rep tell me to use it in conjunction with component separation procedures. Not that that is right. Just more info. 
Yes. Good Point!
We do use it with component separation procedures if we do not do a hernia repair.
If we do a hernia repair with mesh and component separation, we use the mesh add on code as appropriate instead of the 15777.
I would feel very comfortable using it with an integumentary system code as long as it passes NCCI and does not try to replace a hernia mesh add on code when used in conjunction with hernia repairs.
We do use it with component separation procedures if we do not do a hernia repair.
If we do a hernia repair with mesh and component separation, we use the mesh add on code as appropriate instead of the 15777.
I would feel very comfortable using it with an integumentary system code as long as it passes NCCI and does not try to replace a hernia mesh add on code when used in conjunction with hernia repairs.
cynthiabrown
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how do you bill out component seperation?? do you use a mod if bilateral?
Component Seperation:
If unilateral, I use RT or LT almost always unless the ins company does not accept a RT/LT modifier. The only one I have run across is Amerigroup who we bill 15734 only (no modifier) if unilateral.
If bilateral, I use either modifier 50 or enter it twice with a modifier 59. It depends on the insurance company policy. Most ins companies accept 15734-50 for bilateral. I know UHC Secure horizons requires bilateral as 15734, 15734-59.
Anna
If unilateral, I use RT or LT almost always unless the ins company does not accept a RT/LT modifier. The only one I have run across is Amerigroup who we bill 15734 only (no modifier) if unilateral.
If bilateral, I use either modifier 50 or enter it twice with a modifier 59. It depends on the insurance company policy. Most ins companies accept 15734-50 for bilateral. I know UHC Secure horizons requires bilateral as 15734, 15734-59.
Anna
patti_aapc
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15777 add-on code for ENT procedures
My ENT physician wants to bill for 15777 when using Acellular matrix to reconstruct a wound in procedures such as parotidectomies and septoplasty. My system is requesting a primary procedure to be billed with this add-on code even when I bill codes for the septo and/or parotidectomy. Any ideas?
My ENT physician wants to bill for 15777 when using Acellular matrix to reconstruct a wound in procedures such as parotidectomies and septoplasty. My system is requesting a primary procedure to be billed with this add-on code even when I bill codes for the septo and/or parotidectomy. Any ideas?
pcarr
New
Has any one billed with a Laparoscopic Hysterectomy 58570 or 58571 when the physician applies a Bilological Alloderm implant to the cervix to prevent adhesions?