Billing for hernia repair mesh

Determine whether it is appropriate to bill for a mesh inserted during a herniorrhaphy.

Key Points

A: Hernia repair codes do not include the mesh. Codes speci_ cally describing "includes mesh insertion, when appropriate" do include the insertion procedure, however.

Coverage of the mesh itself would be reported by the Part A claim (or facility). You did not indicate whether the provider or the facility purchased the mesh, but typically, the facility pays for the supplies (including mesh) used during the procedure and bills them on the Part A (or facility) claim. As you know, much depends on the insurer's payment policies.

The author is president of Healthcare Consulting Associates of NW Ohio Inc. and is a Medical Economics editorial consultant. She has more than 30 years of experience as a practice management consultant and also is a certified coding specialist, certified compliance officer, and certified medical assistant. Do you have a primary care-related coding question for our experts? Send it