Wiki Medicare payment for 49659 ref 49553

[inman_christine@yahoo.com]

We have billed a 49659 for a lap incarcerated femoral hernia repair but, Medicare is saying it's not covered. We have referenced the open 49553 on the claim.
Is anyone else having issues with Medicare paying for an unlisted code?
Thanks,
Nicole

 

[nickelclaw]

I recommend looking at OP note again and consider 49650 for initial inguinal repair or recurrent 49651. There is no CPT for this type of hernia if incarcerated.
Please look at link below:

https://generalsurgery.ucsf.edu/conditions--procedures/femoral-(thigh)-hernia.aspx

From Coder Desk reference for procedures by Optum
49650-49651

The physician performs laparoscopic repair of an initial (49650) or recurrent (49651) inguinal hernia. The physician places a trocar at the umbilicus and insufflates the abdominal or retroperitoneal cavity. The laparoscope is placed through the umbilical port and additional trocars are placed into the peritoneal or retroperitoneal space. The hernia sac is identified and reduced into the abdominal cavity. A sheet of mesh is placed into the abdominal or retroperitoneal cavity and stapled into place on the pubis and abdominal wall covering the hernial defect. The trocars are removed, and the incisions are closed.