Medical Policy Updates

Notification of Policy Revisions Effective August 30, 2019 (Posted July 1, 2019)

Medical Policy Revision
Bundling Guidelines "Notification" Added to "Topics of Frequent Interest" Hernia repair (43280, 43281, 43332, 43334, 43336) is considered an incidental procedure when performed during the same operative session as bariatric surgery (43644, 43645, 43770, 43775, 43842, 43843, 43845, 43846, 43847). Modifiers 58, 59, 78 and 79 (or XE, XS, XP, XU) will not allow additional payment when appended to these codes. An incidental procedure is not eligible for separate reimbursement. See also corporate medical policy "Surgery for Morbid Obesity". Notification 7/1/19 for effective date of 8/30/19.   
Surgery for Morbid Obesity "Notification" Added the following to the Billing/Coding section:  "Hernia repair (43280, 43281, 43332, 43334, 43336) is considered an incidental procedure when performed during the same operative session as bariatric surgery (43644, 43645, 43770, 43775, 43842, 43843, 43845, 43846, 43847). Modifiers 58, 59, 78 and 79 (or XE, XS, XP, XU) will not allow additional payment when appended to these codes. An incidental procedure is not eligible for separate reimbursement. See also corporate medical policy "Bundling Guidelines".  Notification given 7/1/2019 for policy effective date 8/30/2019.