Wiki Use of AlloMax mesh during open ventral hernia repair

[jamiemarie]

Hello,

I am a little stumpped....my physician states to use 15330 for additional coding of the AlloMax mesh being used during a ventral or incisional hernia repair, as he got that from a coding seminar a few years back.

The code +49568 is the for implantation of the mesh or other prosthesis for open ventral and incisional repairs, does not state what kind of mesh...

Which code is correct to use? I have researched this and have found little to none on hernia repair with use of AlloMax mesh except for surgeon journals. The code 15330 pops up when discussing AlloMax surgical skin grafts, but nothing on coding this code for its use during hernia repairs?

 

[mjewett]

What I can tell you is: if you ask your allomax rep, they most likely will tell you to bill 15330, in addition to 49568, if you use allomax for hernia repair. Some payers will cover it. But I believe from a coding stand point, Coders feel it is not appropriate to use a skin graft code for hernia repair. So there you have it, not really clear cut.

 

[jamiemarie]

Thank you, that is how I feel as well.
There is not a specific code for AlloMax mesh and when researching there is nothing out there. I think that is where my physician got that code from, but some of our payers have reimbursed, however lately I have been seeing denials for medical neccessity with others.

I would think using the 49568 would be the appropriate code to use for now as it is the add on code for mesh, for those hernia repairs. Until I get further documentation I think I'll stick with that.

Thanks for the reply

 

[cmartin]

Medicare wants 49568 for any mesh used for hernia repair. They've got an LCD or NCD, can't remember which. (Our carrier is NGS, they have several states including Indiana, I think KY, NY, & CN)