Wiki Removal of mesh and repair of recurrent hernia

[JADAMS71]

Does anyone know of documentation that states that the removal of hernia mesh is included in the recurrent hernia repair codes or that 20680 is not to be used for hernia mesh? One of the surgeons I code for found this article on the ACS and wants to bill CPT 20680 for the removal of mesh. See the clinical coding example section of this bulletin.

http://bulletin.facs.org/2017/04/hernia-repair-complex-abdominal-wall-reconstruction/#.WqqYzOjwbIU

 

[liloe517]

Occasionally, during a recurrent hernia repair, surgeons must remove implanted mesh from a previous repair. Do not report a separate code for this service. Removal of the old mesh is an included component of the recurrent repair.

https://www.aapc.com/blog/23842-mastering-hernia-repair-and-mesh-placement/



I've always thought of the 20680 as a removal from the bone. When my providers are removing mesh that isn't necessarily infected I use the 49402.

 

[cgaston]

The description of 20680 per the Procedural Reference Guide for Coders:

When the patient is appropriately prepped and anesthetized, the provide reopens the original incision. S/he extends the incision by dissecting through the fascia and muscle layers to access the deep bone implant, such as a rod, pins, wire, screw, metal band, nail or plate. When s/he identifies the deeply inserted implant, s/he unscrews the implant, dissecting it from surrounding tissue as necessary. S/he extracts the deep implant by pulling it out with sharp forceps. s/he closes the wound with layered sutures.

I agree that this is not appropriate for mesh removal.


I look at it this way: there is a code for infected mesh removal because not removing it will affect the patient's health. Removing mesh to re-operate is just part of prepping the operative field and that is why recurrent hernia repairs have higher RVU's.

YMMV