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Thread: Billing mesh with hernias

  1. #1

    Default Billing mesh with hernias

    Can anyone tell me what the ruling is for billing mesh with hernias using
    L8699? I was told to start billing this way.

    I appreciate any info.

    Vickie

  2. #2

    Default

    why were you asked to bill that way. Is it because of contracts? if so, you can not change the way you code a procedure or implant because of the contract. that would not be the closest matching code for hernia mesh.

  3. #3

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    tHEY SAID THAT THEY POLLED OTHER ASC'S ON LISTSERVE AND THEY ARE DOING THIS, AND REALIZES THAT MEDICARE, BCBS & SOMETIMES MEDICAID WOULD NOT PAY.

    I THOUGHT THAT THE ONLY CODE WE COULD BILL WITH MESH WAS THE INCISIONAL AND VENTRAL CODES AND THAT IS USING 49568.

    I NEED TO SEE RULING IN BLACK AND WHITE SO THAT EVERYONE WILL UNDERSTAND.

    I REALLY APPRECIATE ANY INFORMATION.

    VICKIE

  4. #4

    Default

    from coding coach med assests

    HERNIA REPAIR is discussed in the Winter of 1994 CPT Assistant, which states: “The HERNIA REPAIR codes in this section are categorized primarily by the type of HERNIA (inguinal, femoral, incisional, etc.). Some types of hernias are further categorized as “initial” or “recurrent” based on whether or not the HERNIA has required previous REPAIR(s). Additional variables accounted for by some of the codes include patient age and clinical presentation (reducible vs. incarcerated or strangulated). With the exception of the incisional HERNIA REPAIRs (see 49560 49560 49561 49565 - 49566) the use of MESH or other prostheses is not separately reported. The excision/REPAIR of strangulated organs or structures such as testicle(s), intestine, ovaries are reported by using the appropriate code for the excision/REPAIR (eg, 44120, 54520, and 58940) in addition to the appropriate code for the REPAIR of the strangulated hernia. (For reduction and REPAIR of antra-abdominal hernia, see 44050) (For debridement of abdominal wall, see 11042, 11043) (All codes for bilateral procedures in HERNIA REPAIR have been deleted. To report, add modifier -50 or 09950)… The use of MESH or other prosthesis is reported only with the incisional HERNIA REPAIR codes 49560 - 49566. Although MESH or other prosthesis may be used to REPAIR other types of hernias, code 49568 is only reported with the incisional HERNIA REPAIR codes.” HERNIA REPAIR is also addressed in chapter 6 of the CCI Manual, specifically under section D “Digestive System’, which states: “If a HERNIA REPAIR is performed at the site of an incision for an open abdominal procedure, the HERNIA REPAIR 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. When a recurrent HERNIA requires REPAIR, the appropriate recurrent HERNIA REPAIR code is reported. A code for incisional HERNIA REPAIR is not to be reported in addition to the recurrent HERNIA REPAIR unless a medically necessary incisional HERNIA REPAIR is performed at a different site. In this case, modifier -59 should be attached to the incisional HERNIA REPAIR code.” The HERNIA series of CPT code descriptions (CPT 49491-49590) do not mention coding multiple hernias for the same anatomical site. Therefore, based upon the above guidelines, it appears only one HERNIA REPAIR is reported, unless a different REPAIR is performed at a different anatomical site, as supported by your facility documentation. If two or more hernias are REPAIRed at different anatomical site(s), append modifier 59 to the additional HERNIA REPAIR code(s). As a note, the above resources provide instructions to report additional codes when there is "excision/REPAIR of strangulated organs or structures such as testicle(s), intestine, ovaries.” These procedures “are reported by using the appropriate code for the excision/REPAIR (eg, 44120, 54520, and 58940) in addition to the appropriate code for the REPAIR of the strangulated hernia.”


    hope this helps

  5. #5
    Join Date
    Apr 2007
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    Depending on your contracts, you can use L8699, C1781 or 99070. I have carriers that require it reported in different ways, just make sure that the revenue code attached is correct.
    Mary, CPC, CANPC, COSC

  6. #6

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    Thank you so much for the info. The information will be very helpfull.

    Vickie

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