General Surgery Coding Alert

Question: If a surgeon performs a laparoscopic recurrent right inguinal hernia repair, right femoral hernia repair and a laparoscopic left inguinal hernia repair, can the three procedures be billed separately?

New Mexico Subscriber

Answer: Laparoscopic hernia repairs performed on both sides are separately payable, but modifiers -LT (left side) and -RT (right side) must be attached to the appropriate hernia repair code, says Kathleen Mueller, RN, CPC, CCS-P, an independent general surgery coding and reimbursement specialist in Lenzburg, Ill. In this case, the recurrent right inguinal hernia would be billed 49651-RT (laparoscopy, surgical; repair recurrent inguinal hernia-right side) and the left inguinal hernia repair would be coded 49650-LT (laparoscopy, surgical; repair initial inguinal hernia-left side). Although carriers vary, the right femoral repair is probably bundled with the right recurrent inguinal repair.

Without modifiers -LT and -RT, the initial left inguinal hernia repair would be denied because initial repairs are normally bundled with recurrent repairs. Attaching the -LT and -RT modifiers overrides the edit, however, and shows the procedures were performed on different sides. In most cases, the femoral hernia repair is bundled to the recurrent inguinal repair on the same side because the same piece of mesh used to repair the inguinal is usually placed on the femoral hernia as well. If a different piece of mesh is placed over the femoral, however and the documentation clearly and specifically notes that this was done and provides medical necessity for it the femoral repair can be separately billed and should be reimbursed.