General Surgery Coding Alert

Question: Our surgeon repaired an initial incarcerated incisional hernia and closed with a myofascial advancement flap using acellular xenograft (surgimend). Should we code the xenograft as +15777 or 49568?

Utah Subscriber

Answer: The answer depends on how the surgeon used the xenograft -- was the xenograft mesh for the hernia repair, or was it to shore up the advancement flap and help with healing? Your surgeon's documentation should point you in the right direction.

Code the case: You should bill the hernia repair as 49561 (Repair initial incisional or ventral hernia; incarcerated or strangulated) and the flap as 15734 (Muscle, myocutaneous, or fasciocutaneous flap; trunk).

Hernia repair: If the surgeon uses the xenograft mesh for the hernia repair, report +49568 (Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection [List separately in addition to code for the incisional or ventral hernia repair]).

Flap: If the xenograft is part of the flap closure, report new CPT® 2012 code + 15777 (Implantation of biologic implant [e.g., acellular dermal matrix] for soft tissue reinforcement [e.g., breast, trunk] [List separately in addition to code for primary procedure]).