General Surgery Coding Alert

Question: What is the correct coding of a bilateral hernia repair when the left side is an initial repair and the right is a second or recurrent repair? I believe the correct coding would be 49520-RT (repair recurrent inguinal hernia, any age; reducible; right side) and 49505-LT-51 (repair initial inguinal hernia, age 5 years or over; reducible; left side; multiple procedures).
The respective diagnoses would be 550.91(inguinal hernia, without mention of obstruction or gangrene; unilateral or unspecified, recurrent) and 550.90 (inguinal hernia, without mention of obstruction or gangrene; unilateral or unspecified [not specified as recurrent]).

Thomas Antoni, CPC
Washington University School of Medicine
Department of Surgery, Vascular Division

Answer: Although the question refers to bilateral hernia repair, the procedurescorrectlywere not coded as bilateral. Because one hernia was initial and the other recurrent, the procedures are not bilateral and should not be billed that way, says Susan Callaway-Stradley, CPC, CCS-P, an independent coding and reimbursement specialist in North Augusta, SC. These procedures have their own codes and require different levels of expertise, she says. Using 49520 and 49505 is correct, she adds.

The only coding error, Callaway-Stradley says, is the use of modifier -51 (multiple procedures,) attached to the initial hernia code. Instead, modifier -59 (distinct procedural service) should be used because it indicates that the procedures should not be bundled because they were separate and performed on different sites. The -LT (left side) and -RT (right side) modifiers do not affect reimbursement and are used to identify the side of the body on which the procedure took place.