Wiki When to use -59 on ventral hernia repair

[adri3421]

Ok........so ventral hernia repair is usually included in other abdominal procedures like a colectomy.

But a modifier is allowed on the hernia repair in order to bill it with the colectomy.

When is it appropriate to apply the modifier? I've read only if the ventral hernia repair is "recurrent" can you use the modifier -59 for the hernia repair along with a colectomy code. Are there any other situations when it would be appropriate to bill the hernia repair with the colectomy?

 

[shannaron]

It is not appropriate to bill a hernia repair with a colectomy unless there is a separate incision site. And since 9 times out of 10 there will not be a separate incision, billing is not allowed.

 

[colorectal surgeon]

Unfortunately I agree with Shannaron

From the NCCI Policy manual Chapter 6:

4. If a hernia repair is performed at the site of an
incision for an open or laparoscopic abdominal procedure, the
hernia repair (e.g., CPT codes 49560-49566, 49652-49657) is not
separately reportable. The hernia repair is separately
reportable if it is performed at a site other than the incision
and is medically reasonable and necessary. An incidental hernia
repair is not medically reasonable and necessary and should not
be reported separately.