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multiple hernia with mesh again!

  1. Default multiple hernia with mesh again!
    Medical Coding Books

    Can we bill 49568 twice w/o a modifier 59?

    The physician did a bilateral ventral hernia repair, I am billing it as follows:

    49560-50 ( this code has a status indicator 1, in which the 50 applies, right?)

    Is this correct? Do I always need to send out a paper claim to prevent a denial?

    Thanks for your help!

  2. #2
    This is how I would do it and not have any problems getting it paid without having any problems.

    49560-51 59

    Billing medicare I have sent it through electronically and they paid the first time around. The commercial payors I find it a lot less stressful to put it on paper and send it through that way.

  3. Default Reply- I appended thos mods and it was denied, take a look at the op
    I appended the 51 and 59, it was denied. maybe you can look at the report:

    SCRIPTION OF OPERATION: The patient was transported to the
    operating room and placed in a supine position. General endotracheal
    anesthesia was administered. The abdomen was prepped and draped in
    the usual sterile fashion. started the procedure,
    performing a low transverse incision and mobilizing the abdominal wall
    skin flap. At this time, exploration revealed the abdominal wall to
    be diffusely lax in both the right and left lateral abdomen. The
    midline of the abdomen appeared intact. There were no hernias beneath
    the umbilicus. There was diffuse weakness of the lateral abdominal
    wall inferior to the umbilicus and lateral to the rectus muscle. The
    external oblique fascia was extremely attenuated. The external
    oblique was opened over the right lateral abdomen. The external
    oblique was dissected free from the internal oblique. As was diffuse
    weakness in this area, I decided to repair the ventral hernia with
    mesh. A 3-inch x 6-inch piece of Ultrapro mesh with the corners
    trimmed was used for the repair. The mesh was sutured to the shelving
    portion of the external oblique aponeurosis using a running suture of
    2-0 Prolene. The mesh was secured to the conjoined tendon and the
    internal oblique aponeurosis laterally using interrupted U sutures of
    2-0 Prolene. The repair was completed, imbricating the external
    oblique aponeurosis over the mesh and incorporating the mesh with the
    sutures to tighten the defect. This was performed using interrupted
    sutures of 2-0 PDS. The repair appeared very secure after completion.
    Attention was then turned to the left abdominal wall. The external
    oblique aponeurosis was opened in the direction of its fibers. There
    again was diffuse weakness of the abdominal wall. A 3 x 6-inch piece
    of Ultrapro mesh with the corners trimmed was used for this repair
    also. The mesh was secured adjacent to the shelving portion of the
    external oblique aponeurosis using 2-0 Prolene. The superior portion
    of the mesh was then sutured to the conjoined tendon, and also to the
    fascia of the internal oblique aponeurosis laterally using interrupted
    sutures of 2-0 Prolene. The repair was completed, imbricating the
    external oblique aponeurosis over the mesh, incorporating the mesh
    with sutures of 2-0 PDS. This created a very secure-appearing repair.
    The wound was irrigated with saline. At the completion of the
    ventral hernia repair portion of the procedure, all sponge, needle and
    instrument counts were correct. Estimated blood loss was less than 10
    mL. then Dr___completed his portion of the procedure. Please
    refer to separate operative report dictated by him.

    What do you think?
    I thought by it being the same procedure code, it is not considered multiple, it is considered bilateral, and the 50 concept does apply, so why wouldn't we use the 50? I am thinking that is why it was denied- on the denial cliam it sad duplicate claim.

    If anyone else have any thoughts, please share. Thanks!

  4. #4
    Can you try Lt or Rt or would that even apply to this?

    It seems to me that it should get paid with the -50. Have you tried it that way yet or is that what got denied. Here at my hospital we are not even allowed to use the -51 anymore but we are critical access so different guidelines may apply. Anyway, you should be able to use the -50 according to CCI edits. I wouldn't use a -59 on the other mesh code as it is an add-on to the repair code and since you have two repairs, you should be able to have two mesh would think anyway. Maybe a paper claim is the way to go on this one. What do I know...just my opinion...hope it helps


  5. #5
    Default Rt/lt
    I would use RT and LT, that always seems to work with medicare. I have tried the -50 route and always have problems. I would do it this way and send electronically. Good luck!


  6. #6
    We are having the same problems with 49560. We tried billing it as 49560, 49560-50 and we were denied by Medicare. We tried 49560-RT and 49560-LT, and we were denied again. Does anyone know how this should be billed? Is anyone getting paid when performing the 49560 bilaterally?


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