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Wiki Ventral Herna Repair code 49560 with 15830

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Gloria62

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Hello can someone help me!

I'm new to Plastic & Reconstruction and my surgeon wants to bill Ventral Hernia repair 49560 with 15830 Excision excessive skin and subcutaneous tissue. I'm not sure if we can bill those together since he was in the abdomen working to repair the hernia and if so do I use modifier 51 or 59?
 
Will likely deny as incidental and need appeal

My experience with this is that one of the codes will deny as incidental and you or your physician will need to appeal. Yes, the provider was working in the abdomen but the hernia repair is getting into the abdominal wall which is not included in the reimbursement for a panniculectomy. If abdominal wall/muscle work is being done the add on code 15847 is billed but that is usually for a full abdominoplasty and CPT code 15847 is usually not reimbursed by insurance. A hernia repair reimbursement does not include excision of abundant excess skin and tissue of the panniculectomy. From an appeal standpoint, it may help to bill the hernia repair with a 52 modifier for reduced services since you aren't using a separate incision. I would bill with 52 modifier on 49560 and a 59 modifier on 15830. Or bill 15830 with a 22 modifier and a letter to explain additional reimbursement requested for the hernia repair which isn't usually done during a panniculectomy.
 
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