Wiki rec ventral hernia with biologic mesh

[vkratzer]

Is it appropriate to code 49565 and (15430 for the biologic mesh) instead of 49568.

Vicky K

 

[Lujanwj]

Depends on the interpretation of the code. The American College of Surgeons interprets biologic mesh as an "other prosthesis" as described in the description of 49568. With that said, there is nothing from the AMA that confirms or contradicts their stance.

American College of Surgeons
Bulletin
Socioeconomic Tips, September 2011

"49568 - This add-on code applies to any type of mesh or other prosthesis—whether synthetic, biologic, or otherwise. To be clear, when used appropriately as an add-on to hernia repair codes 49560–49566, code 49568 represents any type of mesh or other prosthesis, whether autograft, dermal graft, xenograft, or an as yet to be imagined graft. In addition, code 49568 includes the work of placing the mesh, independent of the size of mesh used. With respect to reporting and reimbursement for the implant, it is the facility's responsibility to report the type and size of mesh used."

Good Luck!

 

[Torilinne]

The acellular xenograft implant is a soft tissue graft. When repairing a hernia, the provider is definitely further down than the soft tissue! I'd stick with the add-on code, 49568.

Tori
CPC, CGIC

 

[Bwray]

bwray

I have been coding Acellular Xenograft Implant with hernia incisional/ventral repairs when the op report has (strattice mesh, porcine mesh) and size documented.
Ingenix EncoderPro lists section guidelines as :
Xenograft 15400-15431
Application of a non-human skin graft or biologic wound dressing (eg, porcine tissue or pigskin) to a part of the recipient's body following debridement of the burn wound or area of traumatic injury, soft tissue infection and/or tissue necrosis, or surgery.

 

[vkratzer]

Thank you. I have also been coding 15430 for biologic mesh implantation. I will call ACOS for further clarification.