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ABN for second hernia repair?

  1. #1
    Question ABN for second hernia repair?
    Medical Coding Books
    Our surgeons do many mutliple hernia repairs through the same incision, but we never get reimbursed back for the second one. Does anybody else run into this problem?

    If so does anyone use ABNs to get the patient to pay for the second one?

    Thanks for any help!

  2. #2
    Location
    Kansas City, MO
    Posts
    431
    Default
    I've never had to bill a patient for a second hernia that wasn't paid for. Sometimes these hernias bundle, and sometimes they don't. When they shouldn't bundle, you appeal and send the op showing the repairs were separate, even if done through the same entry incision.

    Is there a particular type of hernia that you are having problems with?
    Linda Vargas, CPC, CPCO, CPMA, CPC-I, CEMC,CCC
    PMCC Licensed Instructor
    Kansas City, MO Chapter
    President, 2018
    Vice President, 2017
    Member Development Officer 2016
    Harrisonville, MO Chapter President - 2013
    ICD-10 Education Coordinator- 2012
    Chapter President - 2011
    President Elect - 2010

  3. #3
    Default
    What if an epigastric and incisional hernia are done at the same time? Can I add a modifier 59 on the second one?

    Thanks

  4. #4
    Location
    Kansas City, MO
    Posts
    431
    Default
    Maybe....but if there is a repair of a hernia - incisional or umbilical- at the site of the incison...and you are going inside to repair another type of hernia, they usually will bundle the incisonal/umbilical hernia as part of the closure. Unless the two hernias are repaired through two separate incisions, then I would use the -59 and expect payment for both...or if the second (or third) hernia took a lot of time, consider a -22 if the op note supports it.

    http://www.facs.org/ahp/pubs/tips/tips0208.pdf
    I think it talks about this in the second (???) question.
    Linda Vargas, CPC, CPCO, CPMA, CPC-I, CEMC,CCC
    PMCC Licensed Instructor
    Kansas City, MO Chapter
    President, 2018
    Vice President, 2017
    Member Development Officer 2016
    Harrisonville, MO Chapter President - 2013
    ICD-10 Education Coordinator- 2012
    Chapter President - 2011
    President Elect - 2010

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