Wiki Ventral hernia, incidental umbilical hernia, can bill for mesh?

[trinalankford]

We have had a rash of patients recently who are scheduled for a ventral hernia repair, and in the course of their surgery, an incidental umbilical hernia is uncovered. The ventral hernia had mesh associated with it, and CCI says I can bill them together, but the insurance companies are kicking out the mesh...I'm assuming they are pairing the mesh with the umbilical hernia (which is NOT an acceptable bundling per CCI) rather than the ventral.

Should I not be billing for the mesh, since there is now an umbilical hernia associated with it?

 

[annakilker]

ventral hernia with mesh and incidental umbilical hernia

I am paid for the VH and mesh, but no pay for the UH.

 

[trinalankford]

So I'm thinking I should just ICD code the umbilical hernia but leave the CPT code off for the umbilical hernia repair, then, correct?

Thanks for your help.

 

[annakilker]

Ventral hernia, incidental umbilical hernia, can bill for mesh

I agree to leave off the UH repair, and only bill for the VH and mesh.

 

[JSYLVAIN]

Depending on what you consider incidental. If extra work done then bill with 22 modifier. We have billed for both before but sometimes had to send notes/letter explaining two hernias repair (separately) but mesh for ventral as indicated by dx codes.