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Ventral vs. epigastric hernia repair

  1. Default Ventral vs. epigastric hernia repair
    Exam Training Packages
    have a doctor who found out that billing out a "Ventral hernia repair pays much higher than billing out a more specific hernia repair.

    Is it appropriate to default to the (open) ventral hernia repair?

    When is it ever appropriate to use the (open) epigastric hernia repair code alone? (49570)

    Is their anything in writing to support either of these?

    Thanks for your help!!!

  2. #2
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    Milwaukee WI
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    Default Code what was performed
    Never code for the reimbursement. Code what was documented as performed.

    Descriptions from Encoder Pro:
    49570 - The physician repairs an epigastric hernia. The physician makes an incision over the hernia. The hernia sac is identified and dissected from surrounding structures. The fascial defect is identified circumferentially. The hernia is reduced and the hernia sac may be resected. The hernia defect is closed with sutures. The incision is closed.

    49560 - The physician repairs an incisional or ventral hernia. The physician makes an incision over the hernia. Dissection is continued through scar tissue and the hernia sac is identified and dissected from surrounding structures. The fascial defect is identified circumferentially. The hernia is reduced and the hernia sac may be resected. The hernia defect is closed with sutures. The incision is closed.

    The above examples are only two of the possible codes that might be used. But you see right away that the ventral hernia presumes an earlier incision and scar tissue, which would make the surgery more difficult and would result in a higher reimbursement for the additional work.

    Hope that helps.

    F Tessa Bartels, CPC,CEMC

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