Wiki hernia coding - A coding problem came up

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scgcpc2002

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A coding problem came up at our facility... procedure was coded 49561, 49568 and the C code for mesh implantation. The person questioning the procedures was saying that cpt 49561 should never be coded with the C code for mesh...my question is it is a supply we use for the procedure, why shouldn't this be coded as such?
Any help would be appreciated.
Thank you in advance.
 
Inc/Ventral Hernia w/Mesh

What type of facility? I bill for a general surgeon. We do not use the C code because according to HCPCS, the C codes "should only be used by hospital outpatient departments under the prospective payment system."
My physician doesn't supply the mesh, the hospital does.
:)
 
as an ASC, you SHOULD be using the C1781 for the mesh.

Why does this "person" feel that you should not be reimbursed for this?

p.s Medicare will not pay for it because it does have an N1 payment indicator.
 
Hernia Coding

That's how I've been coding and billing these for over two years...maybe more..the other ASC I coded for only used the L8699 codes......
This is a new management team from the East coast who took over in Dec 2008.....and they are going thru what was done last year...
 
Although Mcare wont pay for it, our ASC is freestanding op also and I do code C1781 w/ the 49561, 49568 so you were right all along.:D
 
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