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tci General Surgery Coding Alert - 2007 Issue 6

Reader Question: Rely on Unlisted -- if It's Appropriate

Question: Our surgeons are using a laparoscopic technique for incisional hernia repairs, but we are continuously getting denials for these procedures. One insurance company even stated that we needed a more specific code before they would consider reimbursement. We are using 49659 (Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy). Is there any other code that we can use or any tips on getting this procedure covered? Louisiana Subscriber Answer: Your coding in this case appears to be correct and is supported by CPT and CMS guidelines, which specifically instruct providers to use an unlisted- procedure code when no available code...

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