General Surgery Coding Alert

Question: How should I report the use of AlloDerm (human regenerative tissue), rather than Marlex mesh, during a ventral hernia repair? Should I still report 49568, or is another code more appropriate?

California Subscriber

Answer: In this case (when the surgeon uses AlloDerm instead of mesh for ventral hernia repair), you may consider the AlloDerm to be a prosthesis. Therefore, you may report the placement separately using +49568 (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]).
 
Watch your claims: Remember, you may report 49568 separately only when the surgeon performs the following incisional or ventral hernia procedures:

- 49560 -- Repair initial incisional or ventral hernia; reducible

- 49561 -- ... incarcerated or strangulated

- 49565 -- Repair recurrent incisional or ventral hernia; reducible

- 49566 -- ... incarcerated or strangulated.

For any hernia repairs not listed above -- including epigastric, umbilical, spigelian and inguinal hernia repairs (49570-49651) -- you may not report 49568 separately, regardless of whether the surgeon places mesh or other prosthesis during the repair. The National Correct Coding Initiative recently solidified this guideline by bundling 49568 into all hernia repairs (49570-49651).
 
Consider, also, that you should not report mesh placement separately when using an unlisted-procedure  code for endoscopic hernia repairs (49659, Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy). Instead, you should include full documentation with the claim that explains the surgeon also placed the mesh or other prosthetic.