General Surgery Coding Alert

Medicare calls for unlisted-procedure code, but not all insurers agree

When reporting incisional hernia repairs using laparoscopic technique, you should select unlisted-procedure code 49659 (Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy) for Medicare payers, as recently discussed in General Surgery Coding Alert (Vol. 9, no. 6).

Remember, however, that private payers may specify their own guidelines. Specifically, private payers may require S2075 (Laparoscopy, surgical; repair incisional or ventral hernia).

-Although these temporary national codes are not recognized by Medicare, many other carriers not only accept, but prefer, them to an [unlisted] code,- writes Massachusetts subscriber Pebbles Andrea Ashley, CPC.

And in these cases you may also be able to report S2077 (Laparoscopy, surgical; implantation of mesh or other prosthesis for incisional or ventral hernia repair [list separately in addition to code for the incisional or ventral hernia repair]) if the surgeon places mesh during the hernia repair, Ashley says.

Best advice: Talk to your non-Medicare payers to determine if they will accept S codes for laparoscopic hernia techniques not included in CPT.