Forum - Questions & Answers

May 11th, 2016 - cgpina70

Non-reducible ventral hernia

Can 49255 can be used on a 71 year old with a non-reducible ventral hernia repair with propylene mesh when partial omentectomy had to b e preformed as a separate procedure

May 11th, 2016 - Lupriano58 9 

re: Non-reducible ventral hernia

You asked this in a different way, but the answer is still the same. Medicare CCI edits prevent you from billing these 2 together. Now, if you are billing to commercial insurances that DO NOT follow the CCI edits, the 49255 code is still a separate procedure, and the only time you can use a 59 modifier on a separate procedure is if it is truly distinct.

Here is what CPT® says:
When a procedure or service that is designated as a "separate procedure" is carried out independently or considered to be unrelated or distinct from other procedures/services provided at that time, it may be reported by itself, or in addition to other procedures/services by appending modifier 59 to the specific "separate procedure" code to indicate that the procedure is not considered to be a component of another procedure, but is a distinct, independent procedure. This may represent a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion or separate injury (or area of injury in extensive injuries).

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