General Surgery Coding Alert

Question: While performing an open umbilical hernia repair for a 26 year-old patient, the surgeon documents removing the strangulated hernia sac and placing mesh beneath the hernia site, then suturing the mesh into the tissue surrounding the hernia. This seems like a lot of extra work, and I’m wondering if we can also bill 49568?

Tennessee Subscriber

Answer: No, you should not 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]) as an additional code with an open umbilical hernia repair.

You should bill the procedure as 49587 (Repair umbilical hernia, age 5 years or older; incarcerated or strangulated).

Here’s why: CPT^® instruction for 49568 limits the mesh-implantation add-on code to incisional or ventral hernia repair, not umbilical hernia repair. For umbilical hernia cases that require mesh implantation, the service is part of the procedure code for umbilical hernia repair. That’s because mesh is built into payment for umbilical and inguinal hernia repairs, where it’s common, but not into ventral and incisional repairs, where mesh use is not typical.