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Lap Femoral Hernia Repair

  1. Default Lap Femoral Hernia Repair
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    I have billed a Lap Femoral Hernia repair to Humana (Medicare replacement plan) with CPT 49659 as there is no laproscopic code for a femoral hernia repair. They have denied it stating that unlisted codes are non covered by Medicare. I have gotten feedback on how it should be billed.

    Feedback #1: 49550-22 and add 40% to charge amount

    Feedback#2: 49550-52

    How would you guys bill this. I said #2 because Medicare reimburses less for laproscopic hernia repairs, even though it is more work.

    Any comments/opinions would be greatly appreciated.
    Sonja Little, CPC

  2. #2
    Milwaukee WI
    Default 22 modifier
    I'd use the -22 modifier and add 25% to my usual fee.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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