Outpatient Facility Coding Alert

Published on Tue Jan 21, 2014 PDF

Question: What would be the correct code for the following: left indirect/inguinal hernia was repaired with a mesh plug and repair of indirect hernia of the left side with Gore-Tex suture by approximating the posterior fascia. Is a modifier required in this case?

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Answer: The hernia repair codes are categorized primarily by the type of hernia (inguinal, femoral, incisional, etc). In this case the appropriate code would be 49505 (Repair initial inguinal hernia, age 5 years or older; reducible), assuming the patient is 5 years of age or older. If the patient is under age 5, you would report 49500 (Repair initial inguinal hernia, age 6 months to younger than 5 years, with or without hydrocelectomy; reducible).

Note: Code 49505 is used for inguinal hernia repair and includes the repair of both direct and indirect hernias. A modifier is not required in this case.