Wiki Incisional hernia repair

[carol52]

I hope someone can help me bill this out. I have never billed out 2 incisional hernia repairs before. Dr made 2 seperate incisions. 49561 x's 2. Insurance is Qual Choice. Does anyone have any suggestions ?

 

[MCook]

Most carriers from my experience will only pay for one hernia repair. Also, 49561 does have a MUE of only one. If your physician documented that there was significant amount of work performing both seperate procedures than you could consider using modifier 22 for extra reimbursement. Documentation must support that it was a challanging case and how much additional time was spent fixing the second hernia as the carrier will want to review the op note before providing additional reimubrsement.