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Old 04-23-2010, 11:45 AM
helen helen is offline
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Default Iguinal Hernia repair w/ mesh

Hello! My docs and I have been going back and forth about whether or not we can charge cpt 49568 (Implantation of mesh) in conjuction with 49505. We've recieved payment on some claims and denied on others. Can someone help?
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Old 04-23-2010, 12:16 PM
LTibbetts LTibbetts is offline
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You can only charge for implantation of mesh for ventral and incisional hernias. You can not use it with code 49505, as it is an inguinal hernia and the mesh is included. If you go to your CPT book and read the paragraphs right before that code section, it clearly states this for you. You can show that to your docs for proof.
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Old 04-23-2010, 12:27 PM
codedog codedog is offline
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I agree with Leslie , but maybe your DOC wants payment for the mesh itself. If so some carriers will pay for the mesh itself as a implant,.
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Old 04-24-2010, 09:48 AM
camilleb camilleb is offline
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In my experience, some carriers will pay the mesh w/ modifier 59...even though the CPT book clearly states not to bill for it this way. But, if you look at the CCI edits, for some reason, it allows a 59 modifier. This is a no win situation. The governing resources are showing conflict. I have yet to try billing it with a modifier 22 for those carriers that deny the 59. I wonder if anyone has had success using the 22 modifier? I would suggest keeping track of those carriers that are paying you and of those that don't. Check the payer's guidelines and see what they suggest how you will be paid. Unfortunately for us, we may receive delayed payment either way. Best wishes!
Camille B, CPC
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