Wiki Hernia Mesh...

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awest

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St Augustine, FL
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:confused:What code(s) is the mesh for a hernia included? I have just received several requests for refunds from BC FL stating that they overpaid. This was prior to me being at this facility, but I want to see if I can fight any of them. Thank you for any help!
 
Open ventral or incisional hernia are the only ones you can code the mesh separate. CPT 49560, 49561, 49565, and 49566. All others inclusive.
 
Only open ventral or incisional hernias can code the mesh as an add-on code. Do not use for umbilical or inguinal hernia repair.
 
You might also want to find out if there's an exclusion in your contract with BC FL. BC AZ doesn't pay separately for the mesh unless you include a provision for payment in the contract.
 
awest said:
They are requesting for the money they paid for the mesh itself.
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I would double check your contract to make sure that you have provisions for payment of implants.

If so, then double check to make sure you are filing with the appropriate HCPC as well as appropriate revenue code.

if your contracts says you can get paid for implants I would fight them on it.
 
Thanks, our contract does allow payment of implants. I'm fighting them on a few others as well, they were trying to take back the money for other implants, like tibial tendon grafts used in ACL repairs.
 
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