Work Relative Value Unit Repair initial incisional or ventral hernia; reducible $767.87
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1 Coding and Reimbursement Guide for SurgiMend for Use in Hernia Repair Procedures Hospital Department (HOPD), Setting (ASC) and Physician Fee Schedule Payment Because rates are the only publicly posted rates and many other payers use the payment levels to set their own rates, the figures herein are provided as a frame of reference for customers. The identification of payment rates is not a guarantee of coverage by or other payers. Integra LifeSciences Corporation has used reasonable efforts to provide accurate coding information, but this information should not be construed as providing clinical advice, dictating reimbursement policy or substituting for the judgment of a practitioner. It is always the Provider s responsibility to determine and submit appropriate codes, charges and modifiers for services that are rendered. Integra LifeSciences Corporation assumes no responsibilities or liabilities for the timeliness, accuracy and completeness of the information contained herein. Since reimbursement laws, regulations and payor policies change frequently, it is recommended that providers consult with their payors, coding specialists and/or legal counsel regarding coverage, coding and payment issues. Potential Procedures Using SurgiMend in Ventral Hernia Repair HOPD/ASC Repair initial incisional or ventral hernia; 5341 $2, $1, Repair initial incisional or ventral hernia; Repair recurrent incisional or ventral hernia; 5361 $4, $2, Repair recurrent incisional or ventral hernia; * Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) N/A N/A N/A *Note: With the exception of the incisional hernia repairs (see codes above), the use of mesh or other prosthesis is not separately reportable) Potential Procedures Using SurgMend in Ventral Hernia Repair Physician Fee Schedule Repair initial incisional or ventral hernia; $ Repair initial incisional or ventral hernia; incarcerated or $ Repair recurrent incisional or ventral hernia; $ Repair recurrent incisional or ventral hernia; incarcerated or $ * Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) 4.88 $279.36
2 Potential Procedures Using SurgiMend in Inguinal Hernia Repair HOPD/ASC Repair initial inguinal hernia, age 5 years or older; Repair initial inguinal hernia, age 5 years or older; Repair recurrent inguinal hernia, any age; Repair recurrent inguinal hernia, any age; Repair inguinal hernia, sliding, any age 5341 $2, $1, Potential Procedures Using SurgiMend in Inguinal Hernia Repair Physician Fee Schedule Repair initial inguinal hernia, age 5 years or older; 7.96 $ Repair initial inguinal hernia, age 5 years or older; incarcerated 9.09 $ or Repair recurrent inguinal hernia, any age; 9.99 $ Repair recurrent inguinal hernia, any age; incarcerated or $ Repair inguinal hernia, sliding, any age 8.93 $ Potential Procedures Using SurgiMend in Diaphragmatic Hernia Repair HOPD/ASC Repair, laceration of diaphragm, any approach Repair, neonatal diaphragmatic hernia, with or N/A without chest tube insertion and with or without creation of ventral hernia Repair, diaphragmatic hernia (other than neonatal), traumatic; acute Repair, diaphragmatic hernia (other than neonatal), traumatic; chronic Resection, diaphragm; with complex repair (eg, prosthetic material, local muscle flap) Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; with implantation of mesh Repair, paraesophageal hiatal hernia (including fundoplication), via laparotomy, except neonatal; with implantation of mesh or other prosthesis Repair, paraesophageal hiatal hernia (including fundoplication), via thoracotomy, except neonatal; with implantation of mesh or other prosthesis Repair, paraesophageal hiatal hernia, (including fundoplication), via thoracoabdominal incision, except neonatal; with implantation of mesh or other prosthesis 5362 $7,594,89 N/A
3 Potential Procedures Using SurgiMend in Diaphragmatic Hernia Repair Physician Fee Schedule Repair, laceration of diaphragm, any approach $ Repair, neonatal diaphragmatic hernia, with or without chest tube insertion and with or without creation of ventral hernia Repair, diaphragmatic hernia (other than neonatal), traumatic; acute Repair, diaphragmatic hernia (other than neonatal), traumatic; chronic Resection, diaphragm; with complex repair (eg, prosthetic material, local muscle flap) Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; with implantation of mesh Repair, paraesophageal hiatal hernia (including fundoplication), via laparotomy, except neonatal; with implantation of mesh or other prosthesis Repair, paraesophageal hiatal hernia (including fundoplication), via thoracotomy, except neonatal; with implantation of mesh or other prosthesis Repair, paraesophageal hiatal hernia, (including fundoplication), via thoracoabdominal incision, except neonatal; with implantation of mesh or other prosthesis $6, $ $ $1, $1, $1, $1, $1, Potential Procedures Using SurgiMend in Femoral Hernia Repair HOPD/ASC Repair initial femoral hernia, any age; 5341 $2, $1, Repair initial femoral hernia, any age; incarcerated or Repair recurrent femoral hernia; Repair recurrent femoral hernia; incarcerated or Potential Procedures Using SurgiMend in Femoral Hernia Repair Physician Fee Schedule Repair initial femoral hernia, any age; 8.99 $ Repair initial femoral hernia, any age; 9.92 $ Repair recurrent femoral hernia; 9.39 $ Repair recurrent femoral hernia; $753.11
4 Potential Procedures Using SurgiMend in Umbilical Hernia Repair HOPD/ASC Repair umbilical hernia, age 5 years or older; Repair umbilical hernia, age 5 years or older; 5341 $2, $1, Potential Procedures Using SurgiMend in Umbilical Hernia Repair Physician Fee Schedule Repair umbilical hernia, age 5 years or older; 6.59 $ Repair umbilical hernia, age 5 years or older; incarcerated or 7.08 $ Potential Procedures Using SurgiMend in Laparoscopic Hernia Repair HOPD/ASC Laparoscopy, surgical; repair initial inguinal hernia 5361 $4, $2, Laparoscopy, surgical; repair recurrent inguinal hernia Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); incarcerated or Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); 5362 $7, $3,368.82
5 Potential Procedures Using SurgiMend in Laparoscopic Hernia Repair Physician Fee Schedule Laparoscopy, surgical; repair initial inguinal hernia 6.36 $ Laparoscopy, surgical; repair recurrent inguinal hernia 8.38 $ Laparoscopy, surgical, repair, ventral, umbilical, spigelian or $ epigastric hernia (includes mesh insertion, when performed); Laparoscopy, surgical, repair, ventral, umbilical, spigelian or $ epigastric hernia (includes mesh insertion, when performed); Laparoscopy, surgical, repair, incisional hernia (includes mesh $ insertion, when performed); Laparoscopy, surgical, repair, incisional hernia (includes mesh $1, insertion, when performed); Laparoscopy, surgical, repair, incisional hernia (includes mesh $ insertion, when performed); Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); $1, HCPCS C9358 Dermal substitute, native, non-denatured collagen, fetal bovine origin (SurgiMend Collagen Matrix), per 0.5 square centimeters C9360 Dermal substitute, native, non-denatured collagen, neonatal bovine origin (SurgiMend Collagen Matrix), per 0.5 square centimeters For assistance with coding and reimbursement, please contact our Integra Reimbursement Hotline at , option 3, option 1, Monday to Friday, 8 am to 6 pm, or via at smartreimbursement@integralife.com Reference: Book Current Procedural Terminology () copyright 2017 American Medical Association (AMA). All rights reserved. is a registered trademark of the AMA. Fee Schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Integra and the Integra logo are registered trademarks of Integra LifeSciences Corporation in the ed States and/or other countries. Surgimend is a registered trademark of Integra LifeSciences Corporation or its subsidiaries in the ed States and/or other countries Integra LifeSciences Corporation. All rights reserved.. T ( )
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