Revenue Cycle

Tip: Billing for hernia repair

Medicare Update for CAHs, October 19, 2011

Consider this scenario: A Medicare patient presents to the outpatient surgery department for a surgical repair of an initial reducible inguinal hernia, which the hospital normally charges an all-inclusive flat rate of $5,000 through the chargemaster. The hernia repair was cancelled due to an unexpected drop in the patient’s vital signs after the patient had been taken to the procedure but before induction of anesthesia.

The patient’s hernia repair should be billed as 49505-73 and the charges should be manually reduced to reflect the reduced cost since the procedure was not completed; modifier -73 does not trigger an automatic payment reduction for a CAH like a PPS hospital.<Medicare Claims Processing Manual, Chapter 4 §20.6.4(A)>

This tip was adapted from HCPro’s Medicare Boot Camp® - Critical Access Hospital Version.

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