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General Surgery Coding Alert

Reader Questions:

Reserve +49568 for Incisional,Ventral

Published on Sun Jun 28, 2009

Question: I have a question about 49505 and 49568. I am billing these codes together and some payers are paying and others are not. Medicare is paying. What I can do about the other payers who are following CPTs rules? Texas Subscriber Answer: This is incorrect billing, even if you are getting paid by some payers. You should immediately stop billing 49505 and +49568 together. In fact, you should also refund the carriers that paid you for these codes together. Why? Add-on code +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]) is for incisional and/or ventral hernia repairs only. Therefore, you should never be billing 49568 with 49505 (Repair initial inguinal hernia, age 5 years or older; reducible) because the [...]
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