Wiki Laparoscopic repair of incisional hernia and umbilical hernia, same time

[rachelhall05@yahoo.com]

My provider did Laparoscopic repair of a Right upper quadrant incisional hernia and Laparoscopic repair of incarcerated umbilical hernia at the same time. Can I code for both laparoscopic codes (49655 & 49653) or just use one these codes? I'm a little confused because my first thought would be to use one code but they are in different area's and when I checked the codes in our billing system, it did not kick out stating they could not be billed together or if a modifier was needed. I'm just needing clarification because my provider already was asking to see if he could get credit for both or not. Any advice would be greatly appreciated. Thank you.

 

[NM36]

I believe it depends on the payer. As long as 2 distinct hernias were repaired separately and, for example, mesh was not used to cover both defects, I would try claiming both ( with 59 modifier on line 2), and note for future reference how it pays!
Good luck.

 

[thomas7331]

The NCCI manual's guidance on this is that the second hernia would only be reportable if it is performed through a separate incision, so if this is a Medicare payer, I think you'd want to look at documentation to see if the procedure meets this criteria in order to support the unbundling modifier:

If a hernia repair is performed at the site of an incision for an open or laparoscopic abdominal procedure, the hernia repair (e.g., CPT codes 49560-49566, 49652-49657) 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 shall not be reported separately.