Outpatient Facility Coding Alert

You Be the Coder:

Here's When You Can Bill Hernia Repair & Mesh Separately

Published on Wed Aug 16, 2017

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Question: Some of our surgeons want to be able to bill hernia repairs separately when they perform them with another abdominal procedure. When can they do this?

Answer: According to Christopher Chandler, MHA, MBA, CPC, CGSC, who spoke at the American Academy of Professional Coders’ 2017 Healthcon, you can report hernia repair in addition to another abdominal procedure when:

The hernia site is not the same site as the incision for the other abdominal procedure;
It’s medically necessary (not incidental);
The surgeon has excised a strangulated organ.

Some hernia repairs are incidental, says Chandler, who is a Professional Coding Consultant at Intermountain Healthcare. Often a physician is in one incision site, sees a little hernia, and just repairs it while he’s in there, he explains. If the hernia is strangulated and the physician must remove it by, say, a partial enterectomy, that move would be an example of a separately reportable procedure.

Important note about hernia repair mesh: It’s included in most open and laparoscopic hernia repairs, Chandler noted. The exceptions are ventral and incisional hernia repairs (49560-49566). For those exceptions, the correct code for mesh is +49568. Sometimes, physicians resist the idea that they can’t bill separately for mesh, so they will try to use +15777, Chandler notes. But +15777 should be used only with other integumentary codes, and National Correct Coding Initiative (NCCI) straight up says so, he adds.