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Thread: hernia coding - A coding problem came up

  1. #1

    Default hernia coding - A coding problem came up

    AAPC: Back to School
    A coding problem came up at our facility... procedure was coded 49561, 49568 and the C code for mesh implantation. The person questioning the procedures was saying that cpt 49561 should never be coded with the C code for mesh...my question is it is a supply we use for the procedure, why shouldn't this be coded as such?
    Any help would be appreciated.
    Thank you in advance.

  2. #2

    Default Inc/Ventral Hernia w/Mesh

    What type of facility? I bill for a general surgeon. We do not use the C code because according to HCPCS, the C codes "should only be used by hospital outpatient departments under the prospective payment system."
    My physician doesn't supply the mesh, the hospital does.

  3. #3

    Default hernia coding

    We are a freestanding outpatient facility.

  4. #4
    Join Date
    Apr 2007


    as an ASC, you SHOULD be using the C1781 for the mesh.

    Why does this "person" feel that you should not be reimbursed for this?

    p.s Medicare will not pay for it because it does have an N1 payment indicator.

  5. #5

    Default Hernia Coding

    That's how I've been coding and billing these for over two years...maybe more..the other ASC I coded for only used the L8699 codes......
    This is a new management team from the East coast who took over in Dec 2008.....and they are going thru what was done last year...

  6. #6
    Join Date
    Apr 2007
    orange, ca


    Although Mcare wont pay for it, our ASC is freestanding op also and I do code C1781 w/ the 49561, 49568 so you were right all along.

  7. #7
    Join Date
    Apr 2007


    I'm thinking the management team is going to cost your ASC alot of money if they think like that!!

  8. #8

    Smile hernia coding

    I agree with you!!!

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