NCCI Quick Update:
Nix Mesh Placement for Many Hernia Repairs
Published on Tue Nov 01, 2005
Modifiers can't save you from these bundling edits
You can forget about separate reimbursement for mesh placement during a number of hernia repair procedures. Version 11.3 of the National Correct Coding Initiative bundles add-on code 49568 to 49570-49651, and you won't be able to override these edits with any modifier.
Edits reinforce clinical practice: If you-re coding correctly now, the effects of the mesh placement bundling edits shouldn't trouble you. That's because, as designed by the AMA, +49568 (Implantation of mesh or other prosthesis for incisional or ventral hernia repair) applies to incisional and ventral hernia repairs only, while 49570-49651 describe epigastric, umbilical, spigelian and inguinal hernia repairs.
-Placing mesh takes more time and increases the risk of infection,- but it isn't necessary in most cases, says M. Trayser Dunaway, MD, FACS, a general surgeon in Camden, S.C. -I guess there are some surgeons who might use mesh more often if they were paid more for it- with 49570-49651. But now, -insurers simply pay for a -hernia repair- and leave it up to the surgeon to choose if he-ll use mesh,- Dunaway says. Include Esophagoscopy in Upper GI Scope In the rare case that your surgeon would perform esophagoscopy as described by 43202-43232, you should not report the procedures in addition to upper GI endoscopy 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing). NCCI now bundles 43202-43232 to 43235 and will not allow for separate billing using modifier 59 (Distinct procedural service) or any other modifier.
-This edit extends the prior edit of 43200 (Esophagoscopy, rigid or flexible; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]) with 43235 to include all esophagoscopy therapeutic codes,- says Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and a former member of the CPT advisory panel. -There are now no therapeutic procedures unique to the esophagoscopy codes that cannot be described in an endoscopy code (43235-43255).- The edits should have no negative effects because they only reinforce standard billing conventions for upper endoscope procedures, Weinstein adds.
Now's the time: NCCI 11.3 was effective Oct. 1.