Is There Any Metal In The Mesh Used For Hernia Repair

By Grand. John Verhovskek, MA, CPC
To assign an appropriate hernia repair code from the more than xxx choices that CPT® offers (49491- 49590 and 49650-49659), yous'll probably demand to answer at least 4 of the following 5 questions, and then read carefully through the code descriptors to discover your match.
1. What is the location? For all repairs, you lot must know what blazon of hernia (such as inguinal, femoral, incisional, etc.) the surgeon treats.
two. Is it reducible? The contents of a reducible hernia can be pushed back through the fascial defect. In contrast, the contents of an incarcerated or strangulated hernia are trapped in the hernia sac and cannot exist pushed back through the fascial defect.
3. Initial or recurrent? In other words, is this the first repair at this location, or does the surgeon have to "gear up it once more?"
iv. What is the patient's age? Repair codes for inguinal and umbilical hernias differentiate past patient age.
five. Open or laparoscopic? Never study a laparoscopic process using open approach codes.
Here are four tips to expedite the process:
ane. CPT® lists only iii codes for laparoscopic hernia repair, including two codes for inguinal hernia repair (49650, whatever initial repair and 49561, all recurrent repairs) and a unmarried unlisted-procedure code, 49659, to cover laparoscopic repairs of all other hernia types, regardless of patient age or initial/recurrent, reducible/ strangulated status. If the operative written report specifies a laparoscopic repair, you tin can narrow your choices speedily — at least, until the AMA expands the selection of laparoscopic hernia codes.
Yous may also want to consider S2075 and S2076 for laparoscopic repair of incisional/ventral and umbilical hernias, respectively. S codes are not accustomed past Medicare, simply are accepted past some Blue Cross/Blueish Shield and Health Insurance Association of America payers and by some state Medicaid programs. Check with private payers before deciding betwixt 49659 and S2075-S2076.
two. Inguinal hernia repairs crave the closest attention to particular. CPT® divides open inguinal hernia repairs into four precisely divers age groups. For the youngest patients, you lot'll need to know age from time of gestation.
3. Umbilical repairs besides consider age, merely grouping patients only by "younger than age 5 years" and "older than age 5 years."
4. Scout for "sliding" inguinal hernias. There is a separate, specific code (49525) for repair of a reducible, sliding inguinal hernia. If the hernia is strangulated, yet, 49525 does not apply. Instead, you would revert to 49496, 49501, 49507 or 49521, as appropriate.

Mesh Tin Be Separate

Surgeons will often identify prosthetic mesh to facilitate hernia repair, just coders tin can simply report +49568 separately when the surgeon repairs an incisional/ventral hernia (49560, 49561, 49565, 49566). For all other hernia repairs (epigastric, umbilical, etc., open or laparoscopic), you cannot claim +49568, even if the surgeon places mesh during the repair. Once once again, an exception can occur if your payer will take HCPCS temporary national codes. In that instance, you could report S2077 for laparoscopic mesh placement with incisional/ventral hernia repair, in improver to S2057 (equally discussed in a higher place) for the laparoscopic repair.
Occasionally, during a recurrent hernia repair, surgeons must remove implanted mesh from a previous repair. Do non written report a carve up lawmaking for this service. Removal of the one-time mesh is an included component of the recurrent repair. Don't be fooled by +11008: Although this code describes mesh removal, it is an addition code that applies only to debridement codes 11004-11006. You should not report +11008 with any hernia repair codes. If removal of the mesh requires pregnant additional time or effort, yous may wish to append modifier 22 to the advisable recurrent hernia repair code. Back up your coding with solid documentation describing in detail the extensive nature of the service, for example by comparing it to a "typical" repair.
Finally, a surgeon might remove previously implanted mesh without a recurrent hernia repair, such equally when the patient has erosion of the skin over the mesh or pain related to the implant. In these cases, you can report the mesh removal separately. Payers practice not consider mesh removal a proper foreign body removal. Therefore, you must utilise an unlisted procedure code, such every bit 49999, to report the service. Be sure to include a full operative report with your claim that describes exactly what the surgeon did and why it was necessary, and yous should suggest a value for the procedure.

Hernia Anatomy

An abdominal hernia occurs when the peritoneal lining of the abdominal cavity protrudes through a defect in the fascia that normally contains it. Just stated, the fascia develops a tear, and the peritoneal lining "spills out," in much the same way that an inflated inner tube will bulge out from a cut in the sidewall of a tire. In some cases, simply an empty sac protrudes through the fascia. Just, if the fascial defect is big enough, the sac can incorporate abdominal contents (typically intestines). Clinicians identify hernias primarily by location.
Here are a few of the most of import varieties:
Inguinal: In this common class of hernia (75 percent of all hernias are of the inguinal diversity), the intestine bulges through a weak area in the inguinal culvert in the groin area.
Sliding inguinal: In this case, contents "slide" down the posterior abdominal wall into the inguinal canal, bringing with them overlying abdominal peritoneum. Bodily bowel wall will comprise a portion of the sac.
Notation: Inguinal hernias can be either "direct" (congenital) or "indirect" (acquired), but this is not a factor when coding.
Lumbar: A protrusion through the posterior abdominal wall in the area below the final rib.
Femoral: These hernias occur in the area between the belly and the thigh, usually actualization as a burl on the upper thigh.
Incisional/Ventral: A defect in the abdominal wall at the site of a previous operative incision.
Epigastric: These occur because of weakness in the muscles of the upper-eye abdomen, above the belly button (the epigastric region).
Umbilical: The fascia of the omphalos is thinner than in the residue of the abdomen. An umbilical hernia occurs when contents protrude from the navel.
Spigelian: Besides called a lateral ventral hernia, this is an abdominal hernia through the semilunar or spigelius line (parallel to the lateral boarder of the rectus abdominis musculus).

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Source: https://www.aapc.com/blog/23842-mastering-hernia-repair-and-mesh-placement/

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