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Laparoscopic mesh reinformcement without hernia

  1. #1
    Default Laparoscopic mesh reinformcement without hernia
    Medical Coding Books
    Physician performs a laparoscopic procedure for hernia repair; however, finds no hernia but inserts mesh reinforcement in the inguinal area. Please advise on CPT code for this type of procedure.
    Annette W.

  2. #2
    That's a good question because the insertion of mesh is an add-on code and you can't use add-on codes unless you use the primary code. Maybe an unlisted code and also send in the documentation for the procedure. Sorry I can't be of any help. I did some looking around, too, and couldn't come up with anything. Maybe try to repost question again???
    Last edited by LTibbetts; 03-02-2010 at 10:39 AM.

  3. #3
    Thank you, Leslie, for your research. I apreciate the time spent. This procedures seems to be a trend that is starting, so if anyone else has insight into this, it would be wonderful to hear from you.

    I was thinking unlisted too, but I try so very hard not to use these codes.
    Take care,
    Annette, CPC, CEMC

  4. Default
    the code states that it can be used for hernias or debridements for infection, and that the codes 11004 to 11006 can be used as primary codes as well as the hernia codes. What were the symptoms that led your physician to think this might be a hernia?

  5. #5
    Quote Originally Posted by acw View Post
    Thank you, Leslie, for your research. I apreciate the time spent. This procedures seems to be a trend that is starting, so if anyone else has insight into this, it would be wonderful to hear from you.

    I was thinking unlisted too, but I try so very hard not to use these codes.
    Take care,
    Annette, CPC, CEMC
    I know, I absolutely hate using those unlisted codes, too, but maybe if enough are sent in, then they will look at it and eventually create a code for this particular procedure. It seems to me that I have seen this exact same question before. I did find a code for mesh insertion but it was for preparation of future radiation treatment and I doubt that was what your physician was doing. I am assuming that they thought that there was a hernia and that is why they went in. Good luck and let us know what you do in the end

  6. #6
    Johnson City
    What about billing the hernia code with modifier 52 (reduced), and bill the mesh code too. I would type a note on the claim stating the claim was partially reduced b/c a hernia was not repaired, but mesh was placed for reinforcement.
    Melissa Jewett, CPC

  7. #7
    Fort Worth Texas
    I hesitate to put this on the public forum because I'm not a 100% sure of this but .... I had a similar situation where the doc put in mesh during an open procedure (not a hernia repair) so I was stumped also. He used Permacol mesh which is a pigskin. I did some research and was directed to codes 15430 and 15431. Hopefully this will help you also.

    Good luck!
    Michelle, CPC

  8. #8
    Again, Thank you all soooo much for your thoughts and insight and answers!
    Take care,
    Annette CPC, CEMC

  9. #9
    I have an additional question- what if mesh was already placed prior and during an open procedure the surgeon reinforces mesh without repair of an insicional hernia? I was looking at the 15430 codes but those are under integumentary section and did not think they could apply

  10. Default
    My consensus about this is : A NEGATIVE Laparotomy/ SURGERY, does not mean the surgery is obsolete. The surgery performed is performed for the good cause- for the benefit of doubt towards a better result for the patient. It can be a negative or positive finding.
    In the recent past, (few years before befor ethe advent of laparoscopy and modern teqs), many surgeries were with some negative findings. Well, be happy that the patient did not have the disease in progress.
    For benefit of doubt , these surgeries do have definitive place and values.

    So if the surgery in-tented was ventral or incisional hernia, the placement of the mesh can be reported as well.
    Also it holds good for benefit of the future avoidance of the occurrence, having opened up the abdomen (or by any approach).
    More over the reinforcing mesh framework, gives the abdominal wall and musculature a great additional protection, which is already weak or moribund. But our case of discussion was for Inguinal hernia for which our CPT CLEARLY STATES the 'meshcode' is for incisional and ventral hernias only . There seemes to be a medical reason for saying so.

    Secondly, I have a belief about the code 1543x codes , that though at the integumentary system, it can be applied to abdominal procedures because if they need a definitive closure with(,Like graft or substitute), we can use the appropriate anatomical subsection for primary procedure and this section(integ) for skin graft or skin substitute.

    SO WHY NOT FROM 1543x/ (please see the subsection guidance too)?.
    I would like to know more school of thoughts about this.
    Thank you
    Last edited by preserene; 10-08-2010 at 10:24 AM.

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