Paracolostomy hernia mesh complication

bmcduo2

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Help! I'm really stumped by this one, and would appreciate others' review and opinion.

Medicare pt had a colostomy revision and incarcerated peristomal hernia repair w/mesh 7-9-08, which was coded as 44346; 49568. Then, on 7-14, pt admitted postop w/abdominal pain & wound drainage complications. Op report shows surgeon removed infected mesh, repaired hole in small bowel (Proc note - Repair Enterocutaneous Fistula?) and used AlloDerm to replace mesh for hernia defect. However, operative note states "not a recurrent hernia".

Surgeon's office entered 99222-57; 44640; 11008; 49568.

Really don't think 99222 is appropriate since global complication. Need help on other codes....44640-79 w/10180-78 & 11008? Haven't found any appropriate way to code for Alloderm mesh replacement, since 49568 doesn't have qualifying primary proc and isn't allowed w/11008 due to CCI.

Thanks everyone for taking a look at this.

Barbara :confused:
 

mkj2486

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When I checked the CCI, it stated no bundling issues exist for 11008 and 49568. In fact the notes in CPT state: When insertion of mesh is used for closure, use 49568. So you should be able to bill these together and you shouldn't need a modifier, except for the return to the operating room (78/79 which ever is appropriate for your situation). I put all the codes you mentioned into the CCI and it stated that no bundling issues exist. (44640, 49568, 11008 & 10180)
 
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bmcduo2

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When I checked the CCI, it stated no bundling issues exist for 11008 and 49568. In fact the notes in CPT state: When insertion of mesh is used for closure, use 49568. So you should be able to bill these together and you shouldn't need a modifier, except for the return to the operating room (78/79 which ever is appropriate for your situation). I put all the codes you mentioned into the CCI and it stated that no bundling issues exist. (44640, 49568, 11008 & 10180)
Thanks for your help. While I didn't find any CCI bundling issue between 11008 & 49568, I did see where only 11004-11006 were allowed as qualifying primary px(s) to use with the 49568 mesh add-on code.
 
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