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How do you code for an Incarcerated Ventral Hernia with Mesh and with Partial Omentectomy and Exploratory Laparotomy?

Look at these codes if these are appropriate based on your surgeon's operative report:

For your incarcerated ventral hernia repair ==>> 49561     Repair initial incisional or ventral hernia; incarcerated or strangulated    

Your Partial Omentectomy code is =======>> 49255     Omentectomy, epiploectomy, resection of omentum (separate procedure)

For your Laparotomy code is ==========>> 49000     Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate procedure)


For your MESH, the code is ==========>> 49568      Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair)

Take note that per the CCI Edits:

Your code 49255 (partial ommentectomy) (on column2) is a component of code 49561 (incarcerated ventral hernia repair) (on column 1). With an indication that a modifier is not allowed, so therefore, can not be billed together.

Your code 49000 (exploratory laparotomy) (is on column 2) is also a component of code 49561 (incarcerated ventral hernia repair) (on column 1). With an indication that a modifier is not allowed, so therefore, can not be billed together.

Now, because of this bundling, you can report your hernia repair code 49561 using a modifier 22 (Increased Procedural Services) as like this:

49561-22 (( you might need to submit your claim with the Operative Report to support your surgeon's additional work and time spent on the said procedure.

Your MESH code 49568 has no edits conflict, so you can bill it with your 49561-22.


I hope this helps.

Reference: 2012 CPT Code Book. CPT is owned and a trademark of the AMA (American Medical Association).

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