2016 Reimbursement Guide Hernia Repair

Transcription

1 2016 Reimbursement Guide Hernia Repair SOFT TISSUE REPAIR Right Procedure. Right Product. Right Outcome.

2 Hernia Repair CPT Codes CPT Codes Description Component Separation Technique Muscle, myocutaneous, or fasciocutaneous flap; trunk (Note: Report twice if procedure is bilateral) Hernia Repair Removal of mesh in abdominal wall for infection Repair initial inguinal hernia, age 6 months to younger than 5 years, with or without hydrocelectomy; reducible Repair initial inguinal hernia, age 6 months to younger than 5 years, with or without hydrocelectomy; incarcerated or strangulated Repair initial inguinal hernia, age 5 years or older; reducible Repair initial inguinal hernia, age 5 years or older; incarcerated or strangulated Repair recurrent inguinal hernia, any age; reducible Repair inguinal hernia, sliding, any age Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for 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) Repair umbilical hernia, younger than age 5 years; reducible CPT Codes Description Laparoscopy, surgical, esophageal lengthening procedure (eg, Collis gastroplasty or wedge gastroplasty) (List separately in addition to code for primary procedure) Repair, paraesophageal hiatal hernia (including fundoplication), via laparotomy, except neonatal; without implantation of mesh or other prosthesis 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; without 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; without implantation of mesh or other prosthesis Repair, paraesophageal hiatal hernia (including fundoplication), via thoracoabdominal incision, except neonatal; with implantation of mesh or other prosthesis * CPT Physician status code is C. C = carriers price the code. Carriers will establish RVUs and payment amounts for these services, generally on an individual case basis following review of documentation such as an operative report Repair umbilical hernia, younger than age 5 years; incarcerated or strangulated Repair umbilical hernia, age 5 years or older; reducible Repair umbilical hernia, age 5 years or older; incarcerated or strangulated Laparoscopy, surgical; repair initial inguinal hernia Laparoscopy, surgical; repair recurrent inguinal hernia Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); reducible Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); incarcerated or strangulated Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); reducible Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); incarcerated or strangulated Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); reducible Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); incarcerated or strangulated 49659* Unlisted lap procedure, hernioplasty, hernioorrhaphy, herniotomy Parastomal Hernia Repair Revision of colostomy; with repair of paracolostomy hernia (separate procedure) Hiatal Hernia Repair Repair, diaphragmatic hernia (other than neonatal), traumatic; chronic Repair, diaphragmatic hernia (other than neonatal), traumatic; chronic Laparoscopy, surgical, esophagogastric fundoplasty (eg, Nissen, Toupet procedures) Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; without implantation of mesh Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; with implantation of mesh

3 DRG Codes MS-DRG HCPCS Codes Modifiers Description Hernia Repair 350 Inguinal and Femoral Hernia Procedures with MCC 351 Inguinal and Femoral Hernia Procedures with CC 352 Inguinal and Femoral Hernia Procedures without CC/MCC 353 Hernia Procedures Except Inguinal and Femoral with MCC 354 Hernia Procedures Except Inguinal and Femoral with CC 355 Hernia Procedures Except Inguinal and Femoral without CC/MCC Component Separation Technique Secondary to primary hernia DRG Parastomal 347 Anal and Stomal Procedures with MCC 348 Anal and Stomal Procedures with CC 349 Anal and Stomal Procedures without CC/MCC Hiatal 326 Stomach, Esophageal and Duodenal Procedures with MCC 327 Stomach, Esophageal and Duodenal Procedures with CC 328 Stomach, Esophageal and Duodenal Procedures without CC/MCC Codes Q4100 C1781 L8699 Description Skin substitute, not otherwise specified (i.e. AlloMax Surgical Graft) Mesh (Implantable) (i.e. Davol Synthetic Mesh, AllomMax Surgical Graft, Phasix Mesh, Phasix ST Mesh, XenMatrix Surgical Graft and XenMatrix AB Surgical Graft) (Ambulatory Surgery Center) Codes Description JC Skin substitute used as a graft 50 Bilateral Procedure 51 Multiple Procedures 59 Distinct Procedural Service Revenue Codes Codes Description 272 Sterile supply 278 Other implant *CMS policy on Q codes states they are not to be reported with hernia or breast procedures but private insurer policies may vary. Always confirm coding with your insurer. Definitions: CC = Complications and/or comorbidity MCC = Major Complications and/or comorbidity

4 Hernia Repair ICD-10 Codes Code Code Description Hernia Repair 0YU547Z Supplement Right Inguinal Region with Autologous Tissue Substitute, Percutaneous Endoscopic 0YU54JZ Supplement Right Inguinal Region with Synthetic Substitute, Percutaneous Endoscopic 0YU54KZ Supplement Right Inguinal Region with Nonautologous Tissue Substitute, Percutaneous Endoscopic 0YU647Z Supplement Left Inguinal Region with Autologous Tissue Substitute, Percutaneous Endoscopic 0YU64JZ Supplement Left Inguinal Region with Synthetic Substitute, Percutaneous Endoscopic 0YU64KZ Supplement Left Inguinal Region with Nonautologous Tissue Substitute, Percutaneous Endoscopic 0YU547Z Supplement Right Inguinal Region with Autologous Tissue Substitute, Percutaneous Endoscopic 0YU54JZ Supplement Right Inguinal Region with Synthetic Substitute, Percutaneous Endoscopic 0YU54KZ Supplement Right Inguinal Region with Nonautologous Tissue Substitute, Percutaneous Endoscopic 0YU647Z Supplement Left Inguinal Region with Autologous Tissue Substitute, Percutaneous Endoscopic 0YU64JZ Supplement Left Inguinal Region with Synthetic Substitute, Percutaneous Endoscopic 0YU64KZ Supplement Left Inguinal Region with Nonautologous Tissue Substitute, Percutaneous Endoscopic 0YU547Z Supplement Right Inguinal Region with Autologous Tissue Substitute, Percutaneous Endoscopic 0YU54JZ Supplement Right Inguinal Region with Synthetic Substitute, Percutaneous Endoscopic 0YU54KZ Supplement Right Inguinal Region with Nonautologous Tissue Substitute, Percutaneous Endoscopic 0YU647Z Supplement Left Inguinal Region with Autologous Tissue Substitute, Percutaneous Endoscopic 0YU64JZ Supplement Left Inguinal Region with Synthetic Substitute, Percutaneous Endoscopic 0YU64KZ Supplement Left Inguinal Region with Nonautologous Tissue Substitute, Percutaneous Endoscopic 0YUA47Z Supplement Bilateral Inguinal Region with Autologous Tissue Substitute, Percutaneous Endoscopic 0YUA4JZ Supplement Bilateral Inguinal Region with Synthetic Substitute, Percutaneous Endoscopic 0YUA4KZ Supplement Bilateral Inguinal Region with Nonautologous Tissue Substitute, Percutaneous Endoscopic 0YUA47Z Supplement Bilateral Inguinal Region with Autologous Tissue Substitute, Percutaneous Endoscopic 0YUA4JZ Supplement Bilateral Inguinal Region with Synthetic Substitute, Percutaneous Endoscopic 0YUA4KZ Supplement Bilateral Inguinal Region with Nonautologous Tissue Substitute, Percutaneous Endoscopic 0YUA47Z Supplement Bilateral Inguinal Region with Autologous Tissue Substitute, Percutaneous Endoscopic 0YUA4JZ Supplement Bilateral Inguinal Region with Synthetic Substitute, Percutaneous Endoscopic 0YUA4KZ Supplement Bilateral Inguinal Region with Nonautologous Tissue Substitute, Percutaneous Endoscopic 0YUA47Z Supplement Bilateral Inguinal Region with Autologous Tissue Substitute, Percutaneous Endoscopic 0YUA4JZ Supplement Bilateral Inguinal Region with Synthetic Substitute, Percutaneous Endoscopic 0YUA4KZ Supplement Bilateral Inguinal Region with Nonautologous Tissue Substitute, Percutaneous Endoscopic 0DV44CZ Restriction of Esophagogastric Junction with Extraluminal Device, Percutaneous Endoscopic 0DV44DZ Restriction of Esophagogastric Junction with Intraluminal Device, Percutaneous Endoscopic Code 0DV44ZZ 0YQ50ZZ 0YQ53ZZ 0YQ54ZZ 0YQ60ZZ 0YQ63ZZ 0YQ64ZZ 0YQ50ZZ 0YQ53ZZ 0YQ54ZZ 0YQ60ZZ 0YQ63ZZ 0YQ64ZZ 0YQ50ZZ 0YQ53ZZ 0YQ54ZZ 0YQ60ZZ 0YQ63ZZ 0YQ64ZZ 0YU507Z 0YU50JZ 0YU50KZ 0YU607Z 0YU60JZ 0YU60KZ 0YU507Z 0YU50JZ 0YU50KZ 0YU607Z 0YU60JZ 0YU60KZ 0YU507Z 0YU50JZ 0YU50KZ 0YU607Z 0YU60JZ 0YU60KZ 0YQA0ZZ 0YQA3ZZ 0YQA4ZZ 0YQA0ZZ 0YQA3ZZ 0YQA4ZZ 0YQA0ZZ 0YQA3ZZ 0YQA4ZZ 0YQA0ZZ 0YQA3ZZ Code Description Restriction of Esophagogastric Junction, Percutaneous Endoscopic Repair Right Inguinal Region, Open Repair Right Inguinal Region, Percutaneous Repair Right Inguinal Region, Percutaneous Endoscopic Repair Left Inguinal Region, Open Repair Left Inguinal Region, Percutaneous Repair Left Inguinal Region, Percutaneous Endoscopic Repair Right Inguinal Region, Open Repair Right Inguinal Region, Percutaneous Repair Right Inguinal Region, Percutaneous Endoscopic Repair Left Inguinal Region, Open Repair Left Inguinal Region, Percutaneous Repair Left Inguinal Region, Percutaneous Endoscopic Repair Right Inguinal Region, Open Repair Right Inguinal Region, Percutaneous Repair Right Inguinal Region, Percutaneous Endoscopic Repair Left Inguinal Region, Open Repair Left Inguinal Region, Percutaneous Repair Left Inguinal Region, Percutaneous Endoscopic Supplement Right Inguinal Region with Autologous Tissue Substitute, Open Supplement Right Inguinal Region with Synthetic Substitute, Open Supplement Right Inguinal Region with Nonautologous Tissue Substitute, Open Supplement Left Inguinal Region with Autologous Tissue Substitute, Open Supplement Left Inguinal Region with Synthetic Substitute, Open Supplement Left Inguinal Region with Nonautologous Tissue Substitute, Open Supplement Right Inguinal Region with Autologous Tissue Substitute, Open Supplement Right Inguinal Region with Synthetic Substitute, Open Supplement Right Inguinal Region with Nonautologous Tissue Substitute, Open Supplement Left Inguinal Region with Autologous Tissue Substitute, Open Supplement Left Inguinal Region with Synthetic Substitute, Open Supplement Left Inguinal Region with Nonautologous Tissue Substitute, Open Supplement Right Inguinal Region with Autologous Tissue Substitute, Open Supplement Right Inguinal Region with Synthetic Substitute, Open Supplement Right Inguinal Region with Nonautologous Tissue Substitute, Open Supplement Left Inguinal Region with Autologous Tissue Substitute, Open Supplement Left Inguinal Region with Synthetic Substitute, Open Supplement Left Inguinal Region with Nonautologous Tissue Substitute, Open Repair Bilateral Inguinal Region, Open Repair Bilateral Inguinal Region, Percutaneous Repair Bilateral Inguinal Region, Percutaneous Endoscopic Repair Bilateral Inguinal Region, Open Repair Bilateral Inguinal Region, Percutaneous Repair Bilateral Inguinal Region, Percutaneous Endoscopic Repair Bilateral Inguinal Region, Open Repair Bilateral Inguinal Region, Percutaneous Repair Bilateral Inguinal Region, Percutaneous Endoscopic Repair Bilateral Inguinal Region, Open Repair Bilateral Inguinal Region, Percutaneous

5 Code 0YQA4ZZ 0YUA07Z 0YUA0JZ 0YUA0KZ 0YUA07Z 0YUA0JZ 0YUA0KZ 0YUA07Z 0YUA0JZ 0YUA0KZ 0YUA07Z 0YUA0JZ 0YUA0KZ 0YU707Z 0YU70JZ 0YU70KZ 0YU747Z 0YU74JZ 0YU74KZ 0YU807Z 0YU80JZ 0YU80KZ 0YU847Z 0YU84JZ 0YU84KZ 0YQ70ZZ 0YQ73ZZ 0YQ74ZZ 0YQ80ZZ 0YQ83ZZ 0YQ84ZZ 0YUE07Z 0YUE0JZ 0YUE0KZ 0YUE47Z 0YUE4JZ 0YUE4KZ 0WQF0ZZ 0WQF3ZZ 0WQF4ZZ Code Description Repair Bilateral Inguinal Region, Percutaneous Endoscopic Supplement Bilateral Inguinal Region with Autologous Tissue Substitute, Open Supplement Bilateral Inguinal Region with Synthetic Substitute, Open Supplement Bilateral Inguinal Region with Nonautologous Tissue Substitute, Open Supplement Bilateral Inguinal Region with Autologous Tissue Substitute, Open Supplement Bilateral Inguinal Region with Synthetic Substitute, Open Supplement Bilateral Inguinal Region with Nonautologous Tissue Substitute, Open Supplement Bilateral Inguinal Region with Autologous Tissue Substitute, Open Supplement Bilateral Inguinal Region with Synthetic Substitute, Open Supplement Bilateral Inguinal Region with Nonautologous Tissue Substitute, Open Supplement Bilateral Inguinal Region with Autologous Tissue Substitute, Open Supplement Bilateral Inguinal Region with Synthetic Substitute, Open Supplement Bilateral Inguinal Region with Nonautologous Tissue Substitute, Open Supplement Right Femoral Region with Autologous Tissue Substitute, Open Supplement Right Femoral Region with Synthetic Substitute, Open Supplement Right Femoral Region with Nonautologous Tissue Substitute, Open Supplement Right Femoral Region with Autologous Tissue Substitute, Percutaneous Endoscopic Supplement Right Femoral Region with Synthetic Substitute, Percutaneous Endoscopic Supplement Right Femoral Region with Nonautologous Tissue Substitute, Percutaneous Endoscopic Supplement Left Femoral Region with Autologous Tissue Substitute, Open Supplement Left Femoral Region with Synthetic Substitute, Open Supplement Left Femoral Region with Nonautologous Tissue Substitute, Open Supplement Left Femoral Region with Autologous Tissue Substitute, Percutaneous Endoscopic Supplement Left Femoral Region with Synthetic Substitute, Percutaneous Endoscopic Supplement Left Femoral Region with Nonautologous Tissue Substitute, Percutaneous Endoscopic Repair Right Femoral Region, Open Repair Right Femoral Region, Percutaneous Repair Right Femoral Region, Percutaneous Endoscopic Repair Left Femoral Region, Open Repair Left Femoral Region, Percutaneous Repair Left Femoral Region, Percutaneous Endoscopic Supplement Bilateral Femoral Region with Autologous Tissue Substitute, Open Supplement Bilateral Femoral Region with Synthetic Substitute, Open Supplement Bilateral Femoral Region with Nonautologous Tissue Substitute, Open Supplement Bilateral Femoral Region with Autologous Tissue Substitute, Percutaneous Endoscopic Supplement Bilateral Femoral Region with Synthetic Substitute, Percutaneous Endoscopic Supplement Bilateral Femoral Region with Nonautologous Tissue Substitute, Percutaneous Endoscopic Repair Abdominal Wall, Open Repair Abdominal Wall, Percutaneous Repair Abdominal Wall, Percutaneous Endoscopic Code Code Description 0WUF07Z Supplement Abdominal Wall with Autologous Tissue Substitute, Open 0WUF0JZ Supplement Abdominal Wall with Synthetic Substitute, Open 0WUF0KZ Supplement Abdominal Wall with Nonautologous Tissue Substitute, Open 0WUF47Z Supplement Abdominal Wall with Autologous Tissue Substitute, Percutaneous Endoscopic 0WUF4JZ Supplement Abdominal Wall with Synthetic Substitute, Percutaneous Endoscopic 0WUF4KZ Supplement Abdominal Wall with Nonautologous Tissue Substitute, Percutaneous Endoscopic 0WQF4ZZ Repair Abdominal Wall, Percutaneous Endoscopic 0WQF0ZZ Repair Abdominal Wall, Open 0WQF3ZZ Repair Abdominal Wall, Percutaneous 0WQF0ZZ Repair Abdominal Wall, Open 0WQF3ZZ Repair Abdominal Wall, Percutaneous 0WQF4ZZ Repair Abdominal Wall, Percutaneous Endoscopic 0WQF0ZZ Repair Abdominal Wall, Open 0WQF3ZZ Repair Abdominal Wall, Percutaneous 0WQF4ZZ Repair Abdominal Wall, Percutaneous Endoscopic 0WUF07Z Supplement Abdominal Wall with Autologous Tissue Substitute, Open 0WUF0JZ Supplement Abdominal Wall with Synthetic Substitute, Open 0WUF0KZ Supplement Abdominal Wall with Nonautologous Tissue Substitute, Open 0WUF47Z Supplement Abdominal Wall with Autologous Tissue Substitute, Percutaneous Endoscopic 0WUF4JZ Supplement Abdominal Wall with Synthetic Substitute, Percutaneous Endoscopic 0WUF4KZ Supplement Abdominal Wall with Nonautologous Tissue Substitute, Percutaneous Endoscopic 0WUF47Z Supplement Abdominal Wall with Autologous Tissue Substitute, Percutaneous Endoscopic 0WUF4JZ Supplement Abdominal Wall with Synthetic Substitute, Percutaneous Endoscopic 0WUF4KZ Supplement Abdominal Wall with Nonautologous Tissue Substitute, Percutaneous Endoscopic 0WUF07Z Supplement Abdominal Wall with Autologous Tissue Substitute, Open 0WUF0JZ Supplement Abdominal Wall with Synthetic Substitute, Open 0WUF0KZ Supplement Abdominal Wall with Nonautologous Tissue Substitute, Open 0DQS0ZZ Repair Greater Omentum, Open 0DQS3ZZ Repair Greater Omentum, Percutaneous 0DQS4ZZ Repair Greater Omentum, Percutaneous Endoscopic 0DQT0ZZ Repair Lesser Omentum, Open 0DQT3ZZ Repair Lesser Omentum, Percutaneous 0DQT4ZZ Repair Lesser Omentum, Percutaneous Endoscopic 0JQ70ZZ Repair Back Subcutaneous Tissue and Fascia, Open 0JQ73ZZ Repair Back Subcutaneous Tissue and Fascia, Percutaneous 0JQC0ZZ Repair Pelvic Region Subcutaneous Tissue and Fascia, Open 0JQC3ZZ Repair Pelvic Region Subcutaneous Tissue and Fascia, Percutaneous 0JQM0ZZ Repair Left Upper Leg Subcutaneous Tissue and Fascia, Open 0JQM3ZZ Repair Left Upper Leg Subcutaneous Tissue and Fascia, Percutaneous 0JQN0ZZ Repair Right Lower Leg Subcutaneous Tissue and Fascia, Open 0JQN3ZZ Repair Right Lower Leg Subcutaneous Tissue and Fascia, Percutaneous Parastomal 0WQFXZ2 Repair Abdominal Wall, Stoma, External Hiatal 008Q0ZZ Division of Vagus Nerve, Open 008Q3ZZ Division of Vagus Nerve, Percutaneous 008Q4ZZ Division of Vagus Nerve, Percutaneous Endoscopic 0DQ70ZZ Repair Stomach, Pylorus, Open

6 Hernia Repair ICD-10 Codes Code 0DQ73ZZ 0DQ74ZZ 0DQ77ZZ 0DQ78ZZ 0DV44CZ 0DV44DZ 0DV44ZZ 0DQ60ZZ 0DQ63ZZ 0DQ67ZZ 0DQ68ZZ 0DV60CZ 0DV60DZ 0DV60ZZ 0DV63CZ 0DV63DZ 0DV63ZZ 0DV64DZ 0DV64ZZ 0DV67ZZ 0DV68ZZ 0BQR4ZZ 0BQS4ZZ 0BUR47Z 0BUR4JZ 0BUR4KZ 0BUS47Z 0BUS4JZ 0BUS4KZ 0BQR0ZZ 0BQR3ZZ 0BQS0ZZ 0BQS3ZZ 0BUR07Z 0BUR0JZ 0BUR0KZ 0BUS07Z 0BUS0JZ 0BUS0KZ 0BQR0ZZ 0BQR3ZZ 0BQR4ZZ 0BQS0ZZ 0BQS3ZZ 0BQS4ZZ 0BUR07Z 0BUR0JZ 0BUR0KZ Code Description Repair Stomach, Pylorus, Percutaneous Repair Stomach, Pylorus, Percutaneous Endoscopic Repair Stomach, Pylorus, Via Natural or Artificial Opening Repair Stomach, Pylorus, Via Natural or Artificial Opening Endoscopic Restriction of Esophagogastric Junction with Extraluminal Device, Percutaneous Endoscopic Restriction of Esophagogastric Junction with Intraluminal Device, Percutaneous Endoscopic Restriction of Esophagogastric Junction, Percutaneous Endoscopic Repair Stomach, Open Repair Stomach, Percutaneous Repair Stomach, Via Natural or Artificial Opening Repair Stomach, Via Natural or Artificial Opening Endoscopic Restriction of Stomach with Extraluminal Device, Open Restriction of Stomach with Intraluminal Device, Open Restriction of Stomach, Open Restriction of Stomach with Extraluminal Device, Percutaneous Restriction of Stomach with Intraluminal Device, Percutaneous Restriction of Stomach, Percutaneous Restriction of Stomach with Intraluminal Device, Percutaneous Endoscopic Restriction of Stomach, Percutaneous Endoscopic Restriction of Stomach, Via Natural or Artificial Opening Restriction of Stomach, Via Natural or Artificial Opening Endoscopic Repair Right Diaphragm, Percutaneous Endoscopic Repair Left Diaphragm, Percutaneous Endoscopic Supplement Right Diaphragm with Autologous Tissue Substitute, Percutaneous Endoscopic Supplement Right Diaphragm with Synthetic Substitute, Percutaneous Endoscopic Supplement Right Diaphragm with Nonautologous Tissue Substitute, Percutaneous Endoscopic Supplement Left Diaphragm with Autologous Tissue Substitute, Percutaneous Endoscopic Supplement Left Diaphragm with Synthetic Substitute, Percutaneous Endoscopic Supplement Left Diaphragm with Nonautologous Tissue Substitute, Percutaneous Endoscopic Repair Right Diaphragm, Open Repair Right Diaphragm, Percutaneous Repair Left Diaphragm, Open Repair Left Diaphragm, Percutaneous Supplement Right Diaphragm with Autologous Tissue Substitute, Open Supplement Right Diaphragm with Synthetic Substitute, Open Supplement Right Diaphragm with Nonautologous Tissue Substitute, Open Supplement Left Diaphragm with Autologous Tissue Substitute, Open Supplement Left Diaphragm with Synthetic Substitute, Open Supplement Left Diaphragm with Nonautologous Tissue Substitute, Open Repair Right Diaphragm, Open Repair Right Diaphragm, Percutaneous Repair Right Diaphragm, Percutaneous Endoscopic Repair Left Diaphragm, Open Repair Left Diaphragm, Percutaneous Repair Left Diaphragm, Percutaneous Endoscopic Supplement Right Diaphragm with Autologous Tissue Substitute, Open Supplement Right Diaphragm with Synthetic Substitute, Open Supplement Right Diaphragm with Nonautologous Tissue Substitute, Open Code Code Description 0BUR47Z Supplement Right Diaphragm with Autologous Tissue Substitute, Percutaneous Endoscopic 0BUR4JZ Supplement Right Diaphragm with Synthetic Substitute, Percutaneous Endoscopic 0BUR4KZ Supplement Right Diaphragm with Nonautologous Tissue Substitute, Percutaneous Endoscopic 0BUS07Z Supplement Left Diaphragm with Autologous Tissue Substitute, Open 0BUS0JZ Supplement Left Diaphragm with Synthetic Substitute, Open 0BUS0KZ Supplement Left Diaphragm with Nonautologous Tissue Substitute, Open 0BUS47Z Supplement Left Diaphragm with Autologous Tissue Substitute, Percutaneous Endoscopic 0BUS4JZ Supplement Left Diaphragm with Synthetic Substitute, Percutaneous Endoscopic 0BUS4KZ Supplement Left Diaphragm with Nonautologous Tissue Substitute, Percutaneous Endoscopic 0BQR0ZZ Repair Right Diaphragm, Open 0BQR3ZZ Repair Right Diaphragm, Percutaneous 0BQR4ZZ Repair Right Diaphragm, Percutaneous Endoscopic 0BQS0ZZ Repair Left Diaphragm, Open 0BQS3ZZ Repair Left Diaphragm, Percutaneous 0BQS4ZZ Repair Left Diaphragm, Percutaneous Endoscopic 0BQR0ZZ Repair Right Diaphragm, Open 0BQR3ZZ Repair Right Diaphragm, Percutaneous 0BQR4ZZ Repair Right Diaphragm, Percutaneous Endoscopic 0BQS0ZZ Repair Left Diaphragm, Open 0BQS3ZZ Repair Left Diaphragm, Percutaneous 0BQS4ZZ Repair Left Diaphragm, Percutaneous Endoscopic 0BQR0ZZ Repair Right Diaphragm, Open 0BQR3ZZ Repair Right Diaphragm, Percutaneous 0BQR4ZZ Repair Right Diaphragm, Percutaneous Endoscopic 0BQS0ZZ Repair Left Diaphragm, Open 0BQS3ZZ Repair Left Diaphragm, Percutaneous 0BQS4ZZ Repair Left Diaphragm, Percutaneous Endoscopic 0BQR4ZZ Repair Right Diaphragm, Percutaneous Endoscopic 0BQS4ZZ Repair Left Diaphragm, Percutaneous Endoscopic 0BQR0ZZ Repair Right Diaphragm, Open 0BQR3ZZ Repair Right Diaphragm, Percutaneous 0BQS0ZZ Repair Left Diaphragm, Open 0BQS3ZZ Repair Left Diaphragm, Percutaneous CST The following ICD-10 codes are generally equivalent* to this code (83.82): Root Operation R - Replacement Body Part 6 - Subcutaneous Tissue and Fascia, Chest 0JR607Z Replacement of Chest Subcutaneous Tissue and Fascia with Autologous Tissue Substitute, Open 0JR60JZ Replacement of Chest Subcutaneous Tissue and Fascia with Synthetic Substitute, Open 0JR60KZ Replacement of Chest Subcutaneous Tissue and Fascia with Nonautologous Tissue Substitute, Open 0JR637Z Replacement of Chest Subcutaneous Tissue and Fascia with Autologous Tissue Substitute, Percutaneous 0JR63JZ Replacement of Chest Subcutaneous Tissue and Fascia with Synthetic Substitute, Percutaneous 0JR63KZ Replacement of Chest Subcutaneous Tissue and Fascia with Nonautologous Tissue Substitute, Percutaneous Body Part 8 - Subcutaneous Tissue and Fascia, Abdomen 0JR807Z Replacement of Abdomen Subcutaneous Tissue and Fascia with Autologous Tissue Substitute, Open 0JR80JZ Replacement of Abdomen Subcutaneous Tissue and Fascia with Synthetic Substitute, Open

7 Code Code Description 0JR80KZ Replacement of Abdomen Subcutaneous Tissue and Fascia with Nonautologous Tissue Substitute, Open 0JR837Z Replacement of Abdomen Subcutaneous Tissue and Fascia with Autologous Tissue Substitute, Percutaneous 0JR83JZ Replacement of Abdomen Subcutaneous Tissue and Fascia with Synthetic Substitute, Percutaneous 0JR83KZ Replacement of Abdomen Subcutaneous Tissue and Fascia with Nonautologous Tissue Substitute, Percutaneous Root Operation U - Supplement Body Part 6 - Subcutaneous Tissue and Fascia, Chest 0JU607Z Supplement of Chest Subcutaneous Tissue and Fascia with Autologous Tissue Substitute, Open 0JU60JZ Supplement of Chest Subcutaneous Tissue and Fascia with Synthetic Substitute, Open 0JU60KZ Supplement of Chest Subcutaneous Tissue and Fascia with Nonautologous Tissue Substitute, Open 0JU637Z Supplement of Chest Subcutaneous Tissue and Fascia with Autologous Tissue Substitute, Percutaneous 0JU63JZ Supplement of Chest Subcutaneous Tissue and Fascia with Synthetic Substitute, Percutaneous 0JU63KZ Supplement of Chest Subcutaneous Tissue and Fascia with Nonautologous Tissue Substitute, Percutaneous Body Part 8 - Subcutaneous Tissue and Fascia, Abdomen 0JU807Z Supplement of Abdomen Subcutaneous Tissue and Fascia with Autologous Tissue Substitute, Open 0JU80JZ Supplement of Abdomen Subcutaneous Tissue and Fascia with Synthetic Substitute, Open 0JU80KZ Supplement of Abdomen Subcutaneous Tissue and Fascia with Nonautologous Tissue Substitute, Open 0JU837Z Supplement of Abdomen Subcutaneous Tissue and Fascia with Autologous Tissue Substitute, Percutaneous 0JU83JZ Supplement of Abdomen Subcutaneous Tissue and Fascia with Synthetic Substitute, Percutaneous 0JU83KZ Supplement of Abdomen Subcutaneous Tissue and Fascia with Nonautologous Tissue Substitute, Percutaneous Root Operation X - Transfer Body Part 6 - Subcutaneous Tissue and Fascia, Chest 0JX60ZZ Transfer Chest Subcutaneous Tissue and Fascia, Open 0JX63ZZ Transfer Chest Subcutaneous Tissue and Fascia, Percutaneous Body Part 8 - Subcutaneous Tissue and Fascia, Abdomen 0JX80ZZ Transfer Abdomen Subcutaneous Tissue and Fascia, Open 0JX83ZZ Transfer Abdomen Subcutaneous Tissue and Fascia, Percutaneous Root Operation U - Supplement Body Part F - Trunk Muscle, Right 0KUF07Z Supplement Right Trunk Muscle with Autologous Tissue Substitute, Open 0KUF0JZ Supplement Right Trunk Muscle with Synthetic Substitute, Open 0KUF0KZ Supplement Right Trunk Muscle with Nonautologous Tissue Substitute, Open 0KUF47Z Supplement Right Trunk Muscle with Autologous Tissue Substitute, Percutaneous Endoscopic 0KUF4JZ Supplement Right Trunk Muscle with Synthetic Substitute, Percutaneous Endoscopic 0KUF4KZ Supplement Right Trunk Muscle with Nonautologous Tissue Substitute, Percutaneous Endoscopic Body Part G - Trunk Muscle, Left 0KUG07Z Supplement Left Trunk Muscle with Autologous Tissue Substitute, Open 0KUG0JZ Supplement Left Trunk Muscle with Synthetic Substitute, Open 0KUG0KZ Supplement Left Trunk Muscle with Nonautologous Tissue Substitute, Open 0KUG47Z Supplement Left Trunk Muscle with Autologous Tissue Substitute, Percutaneous Endoscopic Code Code Description 0KUG4JZ Supplement Left Trunk Muscle with Synthetic Substitute, Percutaneous Endoscopic 0KUG4KZ Supplement Left Trunk Muscle with Nonautologous Tissue Substitute, Percutaneous Endoscopic Body Part H - Thorax Muscle, Right 0KUH07Z Supplement Right Thorax Muscle with Autologous Tissue Substitute, Open 0KUH0JZ Supplement Right Thorax Muscle with Synthetic Substitute, Open 0KUH0KZ Supplement Right Thorax Muscle with Nonautologous Tissue Substitute, Open 0KUH47Z Supplement Right Thorax Muscle with Autologous Tissue Substitute, Percutaneous Endoscopic 0KUH4JZ Supplement Right Thorax Muscle with Synthetic Substitute, Percutaneous Endoscopic 0KUH4KZ Supplement Right Thorax Muscle with Nonautologous Tissue Substitute, Percutaneous Endoscopic Body Part J - Thorax Muscle, Left 0KUJ07Z Supplement Left Thorax Muscle with Autologous Tissue Substitute, Open 0KUJ0JZ Supplement Left Thorax Muscle with Synthetic Substitute, Open 0KUJ0KZ Supplement Left Thorax Muscle with Nonautologous Tissue Substitute, Open 0KUJ47Z Supplement Left Thorax Muscle with Autologous Tissue Substitute, Percutaneous Endoscopic 0KUJ4JZ Supplement Left Thorax Muscle with Synthetic Substitute, Percutaneous Endoscopic 0KUJ4KZ Supplement Left Thorax Muscle with Nonautologous Tissue Substitute, Percutaneous Endoscopic Body Part K - Abdomen Muscle, Right 0KUK07Z Supplement Right Abdomen Muscle with Autologous Tissue Substitute, Open 0KUK0JZ Supplement Right Abdomen Muscle with Synthetic Substitute, Open 0KUK0KZ Supplement Right Abdomen Muscle with Nonautologous Tissue Substitute, Open 0KUK47Z Supplement Right Abdomen Muscle with Autologous Tissue Substitute, Percutaneous Endoscopic 0KUK4JZ Supplement Right Abdomen Muscle with Synthetic Substitute, Percutaneous Endoscopic 0KUK4KZ Supplement Right Abdomen Muscle with Nonautologous Tissue Substitute, Percutaneous Endoscopic Body Part L - Abdomen Muscle, Left 0KUL07Z Supplement Left Abdomen Muscle with Autologous Tissue Substitute, Open 0KUL0JZ Supplement Left Abdomen Muscle with Synthetic Substitute, Open 0KUL0KZ Supplement Left Abdomen Muscle with Nonautologous Tissue Substitute, Open 0KUL47Z Supplement Left Abdomen Muscle with Autologous Tissue Substitute, Percutaneous Endoscopic 0KUL4JZ Supplement Left Abdomen Muscle with Synthetic Substitute, Percutaneous Endoscopic 0KUL4KZ Supplement Left Abdomen Muscle with Nonautologous Tissue Substitute, Percutaneous Endoscopic

8 The Davol Reimbursement Hotline Davol s Reimbursement Hotline is dedicated to providing answers to all your reimbursement questions. It also serves as a resource for obtaining accurate billing information and reimbursement support for Davol products Monday through Friday: 8am 5pm, CST This is not a comprehensive list of codes. Coding constantly changes so please reference the AMA and CMS websites and your local providers for additional information. C. R. Bard, Inc. does not guarantee that use of any of the codes noted above will ensure coverage or payment at any particular level. Medicare payment can vary in different sections of the country. Coding and payment can also vary for insurers other than Medicare. Physicians and hospitals should confirm with a particular payor or coding authority, such as the American Medical Association or medical specialty society, which codes or combinations of codes are appropriate for a particular procedure or combination procedures. Reimbursement for a product or procedure can vary depending upon the setting in which the product is used. Coverage and payment policies also change over time, so that information provided here may at some point need to be revised. CPT codes copyright 2015 American Medical Association. All Rights Reserved. CPT is a trademark of the AMA. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/ DFARS Restrictions Apply to Government Use. Healthcare Common Procedure Coding System (HCPCS) Level II codes maintained by Secretary of Health and Human Services (HHS), Centers for Medicare and Medicaid Services, 2015 All rights reserved. International Classification of Diseases, 10th Edition, World Health Organization, Geneva, Switzerland, 2015 Bard, Davol, AlloMax, Phasix and XenMatrix are trademarks and/or registered trademarks of C. R. Bard, Inc. Copyright 2016, C. R. Bard, Inc. All Rights Reserved. DAV/PHSX/1115/0066 Davol Inc. Subsidiary of C. R. Bard, Inc. 100 Crossings Boulevard Warwick, RI Medical Services & Support