Wiki Need help coding LapChole & Umb Hernia

[Hopp]

HI! Wondering if you can code a lap chole & umb. hernia. I put
it through Encoder Pro and it did not bundle; however ins company is
denying as being inclusive. TIA
Deb, CPC

 

[laston]

CCI edits show that they can be billed together, however, some insurance carriers use their own claims check system. I know BCBS, Aetna and UHC all have their own claims checks and will not pay if their systems bundles them. You can try appealing using CMS guidelines. Good luck!

 

[bran1120]

In order for the umbilical hernia to be payable the op note will need to indicate that it was a separately identifiable procedure. In general, the repair of the umbilical hernia is a necessary part of the lap chole closure (the umbilical incision for the lap chole cannot be closed without repairing the hernia) therefore is not separately payable.