Infected Mesh Removal

Can anyone guide me on a code for excision of infected mesh? My physician documented it as CPT® 11008, however this is an add-on code. When I brought up that we need to also bill 11004-11006 (in this case 11005), he said "I thought about using that CPT® code but it was not a necrotizing soft tissue infection. Most mesh removals are not for necrotizing infection but rather an infected mesh that cannot be sterilized with antibiotics."

I am not coming up with any other alternatives.
Diagnosis: Infected mesh, anterior abdominal wall from epigastrium to symphysis pubis.
Procedure: Excision of mesh & suture granulomas, midline fascia

Any help would be appreciated, thank you!

re: Infected Mesh Removal

Have you tried looking at 49402?

re: Infected Mesh Removal

Yes actually, I mentioned that to him as well. He stated the mesh was in the abdominal wall and not the abdominal cavity. Another post I got back on the AAPC website says to use 11005 and 11008, that it does not have to be necrotizing tissue to use 11005. Thoughts on that? (and thanks for your first reply!)

re: Infected Mesh Removal

I have used both those codes in the past. I guess it's your call. You can also go unlisted and bill 49999.

re: Infected Mesh Removal

I also found this article online..............

Q. What is the CPT® code for removal of infected mesh when this is the only procedure performed? The mesh was originally placed for an inguinal hernia repair a couple years ago. Now it is infected and was removed. How do you correctly code this?

Answer - Typically we suggest using CPT® codes:

11004 ~ Debridement of skin for necrotizing soft tissue infection
and
+11008 ~ Removal of prosthetic material or mesh, abdominal wall
for necrotizing soft tissue infection

Since CPT® code +11008 is an add-on code it cannot be reported separately. In a situation where the only procedure performed was the removal of the infected mesh, we suggest using the unlisted code:

49999 ~ Unlisted procedure, abdomen, peritoneum and omentum

And add "removal of infected mesh seperate procedure" or "removal of infected mesh, late effect" in Box 19 of the HCFA / CMS 1500 form.

re: Infected Mesh Removal

found another website stating the same thing as previous. I guess you are going unlisted :)

Removal Only Means Unlisted Procedure

You can report mesh removal separately in some circumstances, Bucknam says.

"I would recommend an unlisted-procedure code if you have mesh removal without repair of a new hernia--for example, when the patient has erosion of the skin over the mesh or some pain related to the implant," she says.

For procedures of this type, you'll most likely report 49999 (Unlisted procedure, abdomen, peritoneum and omentum) with a diagnosis of 996.60 (Infection and inflammatory reaction due to unspecified device, implant and graft). You will have to provide the payer with complete documentation to describe the procedure.

One to avoid: CPT® +11008 (Removal of prosthetic material or mesh, abdominal wall for necrotizing soft tissue infection [list separately in addition to code for primary procedure]) seems perfect to describe removal of mesh, either with or without hernia repair. But 11008 is an add-on code for use with 11004-11006 only. These codes describe extensive debridement performed on high-risk patients for conditions such as Fournier's gangrene (608.83).

In other words: You should not report 11008 for removal of infected mesh only, or for mesh removal with any hernia repair.

re: Infected Mesh Removal

Perfect, thanks so much your help, I really appreciate it!

re: Infected Mesh Removal

You are so welcome!