My doctor wanted to test the new hernia codes with robotic primary procedures being done. Our biller asked about a larger umbilical when I said smaller 1cm to 3cm 49591 and 49592 hadn't been paying, even if they said separate excision? She said it had paid for the larger one so she was going to ask ACS, the reply is below.
The Disclaimer: The material presented herein is, to the best of our knowledge, accurate and factual to date. The information and suggestions are provided as guidelines for coding and reimbursement and should not be construed as organizational policy. The American College of Surgeons disclaims any responsibility for the consequences of actions taken, based on the information presented in this communication.
This made me think I should run it past my AAPC peers for their answers.
Sometimes we get paid is not a good answer, and I have heard this before.
Status: new
Comment by: ACS Hotline
Good morning,
Yes, you can bill the cholecystectomy and the umbilical hernia repair together when the hernia repair is for a pre‑existing defect done through a separate incision/site (not just closure of a trocar/specimen‑extraction site).
For this case, you should code the cholecystectomy as 47562 (without cholangiography) and 49593-59 (or 49593-XS for Medicare) — Repair of anterior abdominal hernia(s) (eg, umbilical), any approach, initial, 3–10 cm, reducible . Add 59/XS (XS for Medicare; 59 for payers that don’t accept XS) to denote a distinct procedure at a separate site/incision from the lap chole. You may have to appeal the claim, but the documentation does support billing both CPT codes.
Thank You,
Julia Jonas
ACS Coding Hotline
Good morning,
Yes, you can bill the cholecystectomy and the umbilical hernia repair together when the hernia repair is for a pre‑existing defect done through a separate incision/site (not just closure of a trocar/specimen‑extraction site).
For this case, you should code the cholecystectomy as 47562 (without cholangiography) and 49593-59 (or 49593-XS for Medicare) — Repair of anterior abdominal hernia(s) (eg, umbilical), any approach, initial, 3–10 cm, reducible . Add 59/XS (XS for Medicare; 59 for payers that don’t accept XS) to denote a distinct procedure at a separate site/incision from the lap chole. You may have to appeal the claim, but the documentation does support billing both CPT codes.
Thank You,
Julia Jonas
ACS Coding Hotline
View the request details and history here:
https://acshotline.acscodingtoday.com/mc/up/my-tickets/55175251
Thanks,
ACS Coding Hotline Help Center Team
questions@acscodingtoday.com
www.facs.org
This information was provided as a service to Fellows of the American College of Surgeons. As a reminder, each year ACS Fellows get 5 free Consultation Units known as CUs. A CU is a 10 minute unit of time. If additional CUs are desired, they can be purchased by replying to this email and requesting an invoice.
Disclaimer: The material presented herein is, to the best of our knowledge, accurate and factual to date. The information and suggestions are provided as guidelines for coding and reimbursement and should not be construed as organizational policy. The American College of Surgeons disclaims any responsibility for the consequences of actions taken, based on the information presented in this communication.
The Disclaimer: The material presented herein is, to the best of our knowledge, accurate and factual to date. The information and suggestions are provided as guidelines for coding and reimbursement and should not be construed as organizational policy. The American College of Surgeons disclaims any responsibility for the consequences of actions taken, based on the information presented in this communication.
This made me think I should run it past my AAPC peers for their answers.
Sometimes we get paid is not a good answer, and I have heard this before.
Status: new
Comment by: ACS Hotline
Good morning,
Yes, you can bill the cholecystectomy and the umbilical hernia repair together when the hernia repair is for a pre‑existing defect done through a separate incision/site (not just closure of a trocar/specimen‑extraction site).
For this case, you should code the cholecystectomy as 47562 (without cholangiography) and 49593-59 (or 49593-XS for Medicare) — Repair of anterior abdominal hernia(s) (eg, umbilical), any approach, initial, 3–10 cm, reducible . Add 59/XS (XS for Medicare; 59 for payers that don’t accept XS) to denote a distinct procedure at a separate site/incision from the lap chole. You may have to appeal the claim, but the documentation does support billing both CPT codes.
Thank You,
Julia Jonas
ACS Coding Hotline
Good morning,
Yes, you can bill the cholecystectomy and the umbilical hernia repair together when the hernia repair is for a pre‑existing defect done through a separate incision/site (not just closure of a trocar/specimen‑extraction site).
For this case, you should code the cholecystectomy as 47562 (without cholangiography) and 49593-59 (or 49593-XS for Medicare) — Repair of anterior abdominal hernia(s) (eg, umbilical), any approach, initial, 3–10 cm, reducible . Add 59/XS (XS for Medicare; 59 for payers that don’t accept XS) to denote a distinct procedure at a separate site/incision from the lap chole. You may have to appeal the claim, but the documentation does support billing both CPT codes.
Thank You,
Julia Jonas
ACS Coding Hotline
View the request details and history here:
https://acshotline.acscodingtoday.com/mc/up/my-tickets/55175251
Thanks,
ACS Coding Hotline Help Center Team
questions@acscodingtoday.com
www.facs.org
This information was provided as a service to Fellows of the American College of Surgeons. As a reminder, each year ACS Fellows get 5 free Consultation Units known as CUs. A CU is a 10 minute unit of time. If additional CUs are desired, they can be purchased by replying to this email and requesting an invoice.
Disclaimer: The material presented herein is, to the best of our knowledge, accurate and factual to date. The information and suggestions are provided as guidelines for coding and reimbursement and should not be construed as organizational policy. The American College of Surgeons disclaims any responsibility for the consequences of actions taken, based on the information presented in this communication.