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coding of umbilectomy with hernia repair

  1. Default coding of umbilectomy with hernia repair
    Medical Coding Books
    Our surgeon did a umbilectomy and then a umbilical hernia was noted and was repaired. When billed 49250-umbilectomy and 49585-umbilical hernia repair, Medicare denied the 49250. Does anyone know how this should have been billed? There was no indication in the CPT that this is a bundled procedure. Thanks

  2. Default coding of umbilectomy with hernia repair
    When checking with CCI edits, it shows CPT 49250 is bundled into CPT 49585. so we can bill with CPT 49585 but a doubt arises as "when performing umbilectomy the complete umbilical cord is removed then what is the use of repairing umbilical hernia" ? - anyone help me that can we bill with CPT 49250 or not.
    Last edited by ashikbabu5@gmail.com; 07-07-2017 at 04:50 AM.

  3. #3
    Default
    CPT code 49250 has a 'separate procedure' designation in CPT, so it is always incidental and bundled to another procedure in the same anatomical location and should never be billed in addition. Under NCCI, a modifier cannot be used to override this bundling.

  4. #4
    Default
    NCCI Manual States:

    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.
    CPC-P-A (11/2016), COC-A (9/2016), CPC-A (11/2015), PAHM (2010)
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