ventral hernia repair with accelular dermal matrix

nuts

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My doctor did a ventral hernia repair (49561) with accelular dermal matrix(15777). According to cpt book, code 49561 is not one of the primary codes that can be used with 15777. I believe code
49568 may be more appropriate to use. please let me know what you think.
 

nlbarnes

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Mesh

Can you tell me please why the +49568 is pertaining to a ventral hernia? My surgeon thought it would be +15777. Also, I think I saw a forum awhile back that discusses the fact that the code descriptor in Encoder doesn't list the primary codes that allows for +15777 & there really isn't any reference. So this has made me curious as well.

A 18 x 22 piece of Ovitex was then cut after washing it with
bacitracin-soaked saline solution. The mesh was cut to an oblong and
football-shaped. In total, 400 sq cm of Ovitex was utilized. It was
placed in the posterior rectus , intrabdbominal plane to reinforce the
repair of soft tissue. Utilizing several interrupted and parachuted 1-
PDS sutures, the Ovitex was sewn into place with mattress sutures through
the rectus muscle flaps. A significant underlay was designed
approximately 3-4 cm in either direction. Along the right and left side
of the rectus muscle flaps, just at the lateral border of each side of
the rectus, the parachuted and quilted 1-PDS sutures were inlaid into
position, first going outside on the ventral portion of the muscle
internally, taking a bite of mesh and then back through the ventral
border of the muscle. These were secured with clamps in a 360 degree
fashion to allow parachuting. At the midportion centrally and laterally,
because the periumbilical skin island was blocking the site of the
suture, internal sutures were placed with 2-0 PDS suture. A drains was
also placed in this space.
 

jdibble

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Can you tell me please why the +49568 is pertaining to a ventral hernia? My surgeon thought it would be +15777. Also, I think I saw a forum awhile back that discusses the fact that the code descriptor in Encoder doesn't list the primary codes that allows for +15777 & there really isn't any reference. So this has made me curious as well.

If you read the instructional notes in the CPT book under code 15777 in tells you that "for implantation of mesh or other prosthesis for open incisional or ventral hernia repair, use 49568 in conjunction with 49560-49566." It also states that "for biologic implants for soft tissue reinforcement in tissues other than breast and trunk, use 17999". There are also a number of other notes giving specific codes to use in other circumstances. If you look at the description of 49568 you will see that it is used for open incisional or ventral hernias. If there is a specific code for that procedure, then that is the code you would use.

I have only used 15777 for Aloderm placed during breast surgeries. As far as a list of primary codes that allows 15777 - I would say to follow the guidelines under the code to see if a code is suggested for the surgery performed and if not, then you could probably use 15777.
 
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It's essentially based off the purpose (as well as the guidelines). If you read the descriptions, you'll see the difference.

SuperCoder says:

15777 "Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure)"
During a breast or trunk soft–tissue procedure, the provider attaches a biologic implant to reinforce the tissue.

Clinical Responsibility
At the same session as a breast or trunk soft tissue procedure, the provider prepares a biologic implant as required, e.g. hydration, shaping, etc. The provider positions the implant in the proper location and manner to produce a scaffolding effect for tissue reinforcement, and attaches the implant, e.g., by suturing. After the complete procedure is finished, the wound is closed and dressed in the usual manner."

49568 "Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair)"

During the same session in which the provider performs a repair of an open incisional or ventral hernia, a hernia which occurs at the site of a previous surgical incision with protrusion of the intestinal contents. He implants surgical mesh to strengthen the repair of the hernia.

Clinical Responsibility
With the patient already prepped and anesthetized for an open incisional or ventral hernia repair, and after he performs the repair, he then proceeds with the implantation of the mesh. He places the mesh over the weak area of the abdomen. He sews the mesh to the area in a way that the weak area of the abdomen remains below it. He removes and places new mesh in the case of an infected ventral hernia. The provider checks for bleeding, removes any instruments, and finally closes the incision."

https://www.supercoder.com/coding-n...logic-implant-code-with-hernia-109674-article
"...New code +15777 was developed for areas where there's a defect from a tumor resection, or where there's a need for fascia support such as a breast situation -- it's not something you're going to use in conjunction with a hernia repair,"...
 
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