2 Hernias Same Side

N70QW

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I don't code surgery very often so I am hopeing someone can help with this one. The pt has an intial right inguinal hernia 49505 and an incarcerated left
inguinal hernia, 49507-51. THis claim is for Medicare and I keep getting it denied for M80 reason code which states basically unbundling. Any suggestions? I am not sure how to bill it bilaterally where they are two different types of hernias. Thanks
 
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I don't code surgery very often so I am hopeing someone can help with this one. The pt has an intial right inguinal hernia 49505 and an incarcerated left
inguinal hernia, 49507-51. THis claim is for Medicare and I keep getting it denied for M80 reason code which states basically unbundling. Any suggestions? I am not sure how to bill it bilaterally where they are two different types of hernias. Thanks
Hi,
Please try and append LT to 49507 and RT to 49505; No need 51 modifier.
I guess both 49505 and 49507 should be coded-as two surgical incisions-two separate codes can be rendered.
 
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hello,
Even the dx should be different for both CPTs.
550.90 for the right inguinal hernia
550.10 for the left hernia, that is incarcerated.
With separate Dxs, a 59 modifier is not mandatory.
 
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-59 modifier

I would probably use the -59 modifier ... but Lavanya has a good point re differing diagnoses. Be sure to link them appropriately.

F Tessa Bartels, CPC, CPC-E/M
 

SM6489

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Hernia repair

:p When billing 49505 bilaterally how do you enter the charge? 49505, 50 modifier, 2 units? Is this correct?
 

codinggrl

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I would not bill with the 50 modifier. This will deny. I would code it as 49507 w/dx 550.10 and 49505-59 w/dx 550.90 ( I assume 49507 is more expensive). I would attach a modifier note with an explanation of the billing and the op report. I did coding for an ASC and this is what I did in the past and it should pay. I would make sure the documentation supports the billing!
 
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