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Urology Coding Alert

Reader Question:

Unilateral Hernia Repair

Published on Fri Feb 01, 2002

Question: Our physician performed an exploration for a bilateral hernia but performed the repair on only one side. How should I bill?

Louisiana Subscriber
Answer: If the urologist performs a hernia repair on one side, and explores the other side but doesn't find a hernia, use 49505 (Repair initial inguinal hernia, age 5 years or over; reducible) with modifiers -50 (Bilateral procedure) and -52 (Reduced services) appended. Reimbursement will probably be 110-120 percent, not the full 150 percent of 49505.
 
If the hernia is strangulated or incarcerated, bill 49507 ( incarcerated or strangulated) with appropriate modifiers depending on exploration of the contralateral side.
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