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Hernia/Wound Repair

  1. Default Hernia/Wound Repair
    Medical Coding Books

    We recently did a wound/hernia repair and I recently read that one cannot bill for a hernia repair if it is not done through a separate incision. Where in CCI would I find this information? We repaired an open non-healing wound through debridement and flap closure, but repaired a hernia/fascial defect prior to closure. We don't do a lot of hernia repairs and the CPT book doesn't say anything about this being bundled.

    Thanks for your help!

  2. Default hernia
    The CCI edits Chapter VI-5 Digestive System codes 40000-49999 states
    "If a hernia repair is performed at the site of an incision for an open abdominal procedure, the hernia repair is not separately reportable." However "it is separately reportable if it is performed at a site other than the incision and is medically reasonable & necessary. An incidental hernia repair is not medically reasonable and necessary and should not be reported separtely."

    Hope that helps.

  3. #3
    Stuart Sailfish Chapter
    Good job Cyndy, took the words right out of my mouth
    Candice Fenildo, CPC, CPMA, CPC-I, CPB, CENTC, CRHC, AAPC Fellow
    Director of Operations
    Ear, Nose and Throat Associates of South Florida, PA

    "Nothing is stronger than the heart of a volunteer"

  4. Default
    I'm not sure that a debridement & flap closure would constitute an open abdominal procedure, of the depth required to make a hernia rpr incidental. Would depend on the size & depth of the wound I guess.
    C.Martin, CPC-GENSG

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