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#1
11-07-2008, 04:58 PM
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2 Hernias Same Side
I don't code surgery very often so I am hopeing someone can help with this one. The pt has an intial right inguinal hernia 49505 and an incarcerated left
inguinal hernia, 49507-51. THis claim is for Medicare and I keep getting it denied for M80 reason code which states basically unbundling. Any suggestions? I am not sure how to bill it bilaterally where they are two different types of hernias. Thanks 
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#2
11-08-2008, 07:58 AM
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Quote:
Please try and append LT to 49507 and RT to 49505; No need 51 modifier. I guess both 49505 and 49507 should be coded-as two surgical incisions-two separate codes can be rendered.
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#4
11-08-2008, 09:42 PM
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hello,
Even the dx should be different for both CPTs. 550.90 for the right inguinal hernia 550.10 for the left hernia, that is incarcerated. With separate Dxs, a 59 modifier is not mandatory.
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#5
11-10-2008, 11:07 AM
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-59 modifier
I would probably use the -59 modifier ... but Lavanya has a good point re differing diagnoses. Be sure to link them appropriately.
F Tessa Bartels, CPC, CPC-E/M
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When billing 49505 bilaterally how do you enter the charge? 49505, 50 modifier, 2 units? Is this correct?
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#7
03-17-2009, 07:53 AM
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I would not bill with the 50 modifier. This will deny. I would code it as 49507 w/dx 550.10 and 49505-59 w/dx 550.90 ( I assume 49507 is more expensive). I would attach a modifier note with an explanation of the billing and the op report. I did coding for an ASC and this is what I did in the past and it should pay. I would make sure the documentation supports the billing!
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#8
03-17-2009, 08:20 AM
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Have you considered billing the 49505 twice and applying the 76 modifier to the second one?
Last edited by TammyFarris; 03-17-2009 at 08:24 AM.
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