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Need help coding LapChole & Umb Hernia

  1. #1
    Default Need help coding LapChole & Umb Hernia
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    HI! Wondering if you can code a lap chole & umb. hernia. I put
    it through Encoder Pro and it did not bundle; however ins company is
    denying as being inclusive. TIA
    Deb, CPC

  2. Default
    CCI edits show that they can be billed together, however, some insurance carriers use their own claims check system. I know BCBS, Aetna and UHC all have their own claims checks and will not pay if their systems bundles them. You can try appealing using CMS guidelines. Good luck!

  3. #3
    In order for the umbilical hernia to be payable the op note will need to indicate that it was a separately identifiable procedure. In general, the repair of the umbilical hernia is a necessary part of the lap chole closure (the umbilical incision for the lap chole cannot be closed without repairing the hernia) therefore is not separately payable.

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