Wiki hernia repair - When coding for the repair

[sgochoco]

When coding for the repair of a hernia at the same session as another primary procedure, how do you determine wether or not the hernia should be separately coded. Especially if the repair is done through the same incision as the "other" primary procedure. Some hernia's are bundled, but a modifier is allowed. This can be very confusing. Where can I find out what the guidelines are ? This is for a commercial carrier, but I will follow Medicare since I do not know the guidelines of this carrier.

Thanks

 

[surgonc87]

See the NCCI edits


If a hernia repair is performed at the site of an incision for an open abdominal procedure, the hernia repair (CPT codes 49560-49566) is not separately reportable. The hernia repair is separately reportable if it is performed at a site other than the incision and is medically reasonable and necessary. An incidental hernia repair is not medically reasonable and necessary and should not be reported separately.