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Panniculectomy with Umbilical Hernia Repair

  1. #1
    Oak Ridge
    Question Panniculectomy with Umbilical Hernia Repair
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    NCCI edits for panniculectomy (15830) make this the column two edit of an umbilical hernia repair (49585) when performed at the same time. Our surgeons are performing both procedures. Some carriers consider the panniculectomy cosmetic or excluded while others will pay for this via pre-determination. My question is this: Can we bill the member for the "excluded" or "cosmetic" portion with a signed ABN advising the patient they will be responsible for the panniculectomy and bill the hernia repair to the insurance even though the panniculectomy is the column two edit (meaning it is bundled in the hernia repair)? Our provider has stated this takes about two hours longer then the acutal Roux-en-Y gastric bypass surgery for the patient to loose weight. Can we separate these since they are performed at the same time but one is considered cosmetic? Does anyone else do this and how do you handle this?

  2. Default
    This issue came up recently and one insurance company claims that because of the CCI you can't bill for these procedures together and we had to write off the panniculectomy. Per the insurance company we couldn't bill the patient. But some insurance companies pay us on both! Just another reason why insurance companies drive me crazy.

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