Need Dianosis and Procedure Codes for Hernia Repair?

Question

Had surgery in MX (in 2003), need followup, insurance co. said will pay if MX doc provides codes. MX doc does not take insurance or use codes, but willing to help if I can find the codes for him. Are there codes for procedures and then codes if it is more complicated? I had lap band surgery. Now have hernia through the band. Doc here won't do surgery because band is not US approved. Also, can you tell me what the approved cost is for the code used?

Thanks!

Monica

Answer 1

One thing you can do is call your family doctor and see if someone in their billing department can find you the codes you're looking for.  If they can't help you, call a surgeon's office and see if they can help.  As for what the approved costs is, that will vary due to whatever insurance company you use.  Each company has different contracts that pay different rates, so you'd have to find this information out from your insurance company once you have the ICD9 codes.  They should also be able to tell you what your portion of the bill will cost.

Answer 2

You're better off obtaining this information from a medical office familiar with your specific medical condition.

It sounds like you don't clearly understand what you're asking for, which means that you won't get a reliable answer here.

The procedure code is what defines the procedure you're having done.  The specific type of surgery you're having will have a specific procedure code.

The diagnosis code is what defines your actual condition - whatever reason it is that you're having the surgery.

The information you're giving isn't specific enough to give an accurate answer.  There are multiple procedure codes for a hernia repair, depending on the type of hernia, etc.  And there could be multiple diagnosis codes could be applicable for the surgery, but only a medical office familiar with your specific case would know which one applies to you.

Not using the correct codes could result in your claim being underpaid...or even rejected outright.  I'd definitely consult with a medical provider more specifically familiar with your case.