Wiki Open Ventral hernia repair with panniculectomy

[bethb]

Our patient had a large hernia, approximately the size of a volleyball. Our surgeon elected to perform a partial panniculectomy so the hernia could be closed reasonably without a giant (seroma) cavity. I am having trouble visualizing this. There is a CCI edit between the codes 49561 and 15830.

Would the panniculectomy be considered a separate service since in this instance the patient had a large hernia?

Thanks,
BB

 

[jingle]

Which insurance company? we have billed 49561(mod51), 49568, and 15830 mod(59) to BCBS several times since we checked with McKesson

 

[cbutsko]

Open Ventral Hernia Repair with Panniculectomy

In an instance where I faced virtually the same situation (huge hernia reduced and repaired) where the resulting panniculectomy had to be done in order to effect a closure that was appropriate (not for cosmetic reasons), I billed the panniculectomy with a modifier 59, sent medical records, and it was paid. Unfortunately, I don't recall who the insurance company was. My reasoning was that the panniculectomy would not have been at all necessary had the hernia not been so large. In my mind, that made the panniculectomy necessary and a separate procedure.

I hope this helps,

Cate