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Lap Ventral Hernias & Unlisted codes in general...

  1. #1
    Default Lap Ventral Hernias & Unlisted codes in general...
    Medical Coding Books
    For those that are billing lap ventral hernias (unlisted code 49659)....

    1. Are you able to get mesh 49568 paid in addition to this code for any of your payors? If so, which ones?

    2. If you are not billing or getting paid for 49568, and use ONLY the 49659, do you get higher reimbursement when mesh is used vs. when it is not used? If not, are you appealing asking for more? Any luck?

    3. What is reimbursement like? Is it similar to code 49650? The way I understand it is, ventral hernia repairs are more complex than inguinal hernia repairs. If you compare the open codes (49505 vs. 49560), the ventral code pays approx. $200.00 more (according to my Medicare carrier's website) than the inguinal code. I would think you should expect about the same amount more when they are done laparoscopicly (and even more when mesh is used) ... is this happening?

    3. Do you pay close attention to the reimbursement on this (or any unlisted code you use) to ensure you are being reimbursed fairly?

    4. For this or any unlisted procedures, do you send a letter outlining your reimbursement expectations along w/ the op notes or do you just send the op notes?

    5. Are any payors recognizing S2075 and S2077 or has anyone had luck getting these codes added to their contracts?

    A million thanks in advance to anyone who can provide feedback on any of these questions!!!!!

    : ) Erica


    Erica D. Schwalm, CPC, CPC-GENSG, CMRS

    ~ Free Physician Billing & Coding Resources

  2. Default S2075
    We have an office that is billing the S2075 for Blue Cross and that reimbursement is only $50.


  3. #3
    Sailfish, Stuart, FL
    We do not bill the mesh with 49659 unless the hernia is unusually large or the patient is unusually obese. Then we appeal to the insurance when denied. We have about a 50% success rate with that. We do not increase our price when mesh is used and not billed. We seem to get reimbursed $562 from Medicare for 49659 which seems pretty even with the allowable for 49560 after you add the 20%. Due to the fact that we only send claims electronically, we do not send op notes with the claim, instead we type in space 19 on the HCFA that code 49659 is laparoscopic incisional hernia and is comparable to 49560. Hope this helps.

  4. Default
    We don't bill 49568 with 49659 because the CPT says to use it with 11004-11006 & 49560-49566. We have been using S2075 & S2077 for everyone except Medicare, and most of them seem to pay similarly to 49560 & 49568. One of my bosses rcvd info from one of his professional organizations last year that said they had rcvd approval for additional CPT codes for laparoscopic hernia rprs, but no info on when they'll debut. Can't be soon enough for me!
    C.Martin, CPC-GENSG

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