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Ventral hernia with mesh

  1. #1
    Default Ventral hernia with mesh
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    We are billing a 49553-50, repair femoral hernia, bilateral and 49561, repair ventral hernia then add on code 49568, implantation of mesh. In that order on the HCFA form.
    Medicare always denies the 49568 stating it is bundled with 49553. What am I missing? 49568 is an add on code, no modifier is needed and should not be bundled. Can any of you coders out there tell me what I am doing wrong?

  2. #2
    Personally, I would have added modifier 59 to 49561 then added 49568. This has worked for me in the past. If all else fails do a reconsideration underlining your op note showing the the ventral hernia repair and mesh. Either way you should get paid. Don't give up! Good Luck!

  3. #3
    Thanks, I'll give it a try.

  4. #4
    Denied again. Back to the drawing board

  5. #5
    Medicare stated I need a 59 modifier on the add on code 45968, no other carrier requires it but leave it to Medicare to want a modifier on an add on code.

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