General Surgery Coding Alert

Modifier 22 is the choice for difficult removal during hernia repair

Mesh placement may be common during hernia repair, but you can only bill separately for the procedure in a minority of cases. Make sure you know what they are.

In addition, you should be aware that recurrent hernia repair usually includes mesh removal, unless the physician can document extraordinary effort. 1. Claim Placement With Incisional/Ventral Hernia You may report separate placement of mesh (+49568, Implantation of mesh or other prosthesis for incisional or ventral hernia repair) only when the surgeon repairs an incisional or ventral hernia, says Kathleen Mueller, RN, CPC, CCS-P, a registered nurse and reimbursement and coding specialist in Lenzburg, Ill.

Get the specifics: You may report 49568 with 49560 (Repair initial incisional or ventral hernia; reducible), 49561 (... incarcerated or strangulated), 49565 (Repair recurrent incisional or ventral hernia; reducible) and 49566 (... incarcerated or strangulated) when the surgeon documents mesh placement during the hernia repair. 2. Skip Separate Placement Code for All Others For any hernia repairs not listed above--including epigastric, umbilical, spigelian and inguinal hernia repairs (49570-49651)--you should not separately report 49568, regardless of whether the surgeon places mesh during the repair. The National Correct Coding Initiative recently solidified this guideline by bundling 49568 into all hernia repairs 49570-49651.

Example: -If the operative report documents, -Repair of epigastric hernia [for instance, 49570, Repair epigastric hernia (e.g., preperitoneal fat); reducible (separate procedure)] with marlex mesh,- the mesh isn't separately billable because you can only add 49568 to 49560, 49561, 49565 or 49566,- Mueller says. 3. Removal + Repair = No Separate Payment If the surgeon removes infected mesh placed during a previous hernia repair when making a recurrent hernia repair, you generally cannot code separately--or receive reimbursement--for the mesh removal.

Although you may be tempted to report an unlisted- procedure or foreign-body-removal code for mesh removal with recurrent repair, this is inappropriate.

-Keep in mind that the surgeon is already getting paid more for using the -recurrent- code,- says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, CEO of Coding and Reimbursement Network Inc., in Egg Harbor City, N.J. -The payer expects the recurrent repair to be more work than an initial repair due to scar tissue, adhesions and mesh issues.-

Bottom line: Codes for recurrent repairs (for example, 49520, Repair recurrent inguinal hernia, any age; reducible) include as an integral component removal of mesh placed during a previous hernia repair. Modifier 22 Provides an Option When removing mesh requires truly extensive effort, you may be able to gain additional reimbursement by appending modifier 22 (Unusual procedural services) to the appropriate recurrent hernia repair code. But, be prepared to back your claim up with extensive documentation.

-You just don't get extra money for [mesh [...]