Changes in Mesh Placement Reimbursements

Changes in CPT coding can be a blessing or a curse. In some caes it can mean more reimbursement dollars and in others it can mean less. When dealing with mesh placement for hernia repairs, medical billing may bring you less reimbursement for your services. The medical billing policy that has been updated no longer allows mesh placement to be separately reimbursable in relation to certain hernia repair surgeries.

The National Correct Coding Initiative now has the medical billing CPT code 49568 bundled with 49570-49651. 49570-49651 describes umbilical, epigastria, spieling, and inguinal hernia repairs. Now, you medical billing can no longer include both of these codes for separate reimbursement. A modifier should not be used when coding these claims as a general rule of thumb.

The CPT code 49568 means: Implantation of mesh or other prosthesis for Incisional of Ventral hernia repair. All the other types of hernia surgeries don’t actually need mesh placement. In hernia repairs such as inguinal repairs, mesh is not needed. Studies have shown that it only causes more chance of infection after surgery. If a particular surgeon still feels mesh should be placed during this surgery, it will no longer be reimbursed on their medical billing claims without high documentation as to the medical necessity of the procedure.

View all Articles by: Melissa Clark, CCS-P