General Surgery Coding Alert

Answer: There are two separate codes for initial and recurrent inguinal hernia; therefore a modifier -50 (bilateral procedure) would not be appropriate, says Tammy Chidester, CPC, billing supervisor for Upshore Medical Management Services in Buckhammon, W.Va. A modifier -50 should be used only if exactly the same service was performed bilaterally. Modifier -51 is the correct modifier to use when multiple procedures are performed at the same session by the same physician.

For example, a surgeon has a patient older than 5 years of age and both hernias are reducible, the right side is initial and the left side is recurrent. You would use 49505-RT (repair initial inguinal hernia, age 5 years or over; reducible; right side) for the initial hernia and 49520-51-LT (repair recurrent inguinal hernia, any age; reducible; multiple procedures; left side) for the recurrent hernia. The RT (right) and LT (left) modifiers will help to keep your initial hernia from being denied as pre-existing. Make sure to code hernias according to these criteria: initial vs. recurrent, reducible vs. incarcerated or strangulated, and age of the patient.