Muscle repair and hernia repair both added charges with DIEP flap surgery?

A hernia may need to be fixed during your surgery as this is an actual defect in the abdominal wall fascia. The DIEP procedure further weakens the fascia by incising through it in order to retrieve the blood vessels. Therefore, the hernia repair may be necessary and may results in additional charges since it is billed separately. Rectus diastasis repair, in which the separation of the abdominal muscles is performed (but the fascia remains intact), is typically not performed during a DIEP flap reconstruction. These are not performed together because, among the risk of other things, the risk of blood clots or venous thromboembolis (VTE). If your surgeon does decide to pursue this, it may result in an additional charge.

I always repair the muscle fascia with underlay mesh and almost always perform a rectus plication of the rectus abdominis muscles above the belly button. I get insurance approval for the repair if I can and only charge insurance if it is approved. I never charge patients.