Forum - Questions & Answers

May 11th, 2016 - cgpina70

Ventral Hernia with mesh

Can CPT® code 49561 be coded and include 49568, 49255 with modifiers 59

May 11th, 2016 - afgbilling 59 

re: Ventral Hernia with mesh

CCI edit: This procedure code can never be reported together with code 49561 due to CCI column 2 code edit

May 11th, 2016 - Lupriano58 9 

re: Ventral Hernia with mesh

If you are coding 49561 for the repair of initial incisional or ventral hernia; reducible incarcerated or strangulated and you also placed mesh (49568), yes you can bill those 2 together, and you would NOT place a 51 modifier on 49568 because it is an "add-on" code and is modifier 51 exempt. You do not put 51 modifiers on add-on codes.

Regarding the 49255, Medicare CCI edits will prevent you from being able to bill 49561 and 49255 together because the 49255 has a "0" as its CCI indicator, meaning that you cannot use a 59 modifier to bypass the Medicare edit.
49561 49255 19970101 * 0 CPT® "separate procedure" definition



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