Case #9 Winner, Answer Key, & Rational

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Case #9 Winner, Answer Key, & Rationale

Deborah H. is the winner of case #9. See below for the answer key and rationale.

CPT: 49505
CPT Modifiers: LT
ICD-9: 550.90

The provider performed an inguinal hernia repair on the left side on a 50-year-old patient. There is no indication the hernia is recurring or strangulated or incarcerated. Mesh is bundled when performed during an inguinal hernia repair.

CPT: 49505-LT

Steps to look up: Hernia Repair/Inguinal/Initial, Child 5 years or older

ICD-9-CM: 550.90

Steps to look up: Hernia, hernial/inguinal/unilateral-for the fifth digit
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The AAPC CPC course teaches modifier usage. Although insurance plans will still pay the claim if the LT was not listed, it is best practice for reporting/coding purposes to always report the appropriate modifier. When and if you take the CPC course through the AAPC, your answers will be wrong if you don't report modifiers.
Same with the CPC exam.
Case # 9 clinical added for Answer key & Rationale

Case # 9 clinical added for Answer key & Rationale
Since the clinical info wasn't included in posting of answer & rationale; and the link to case clinical info given now is not accessible (error page shows up) .... I thought it wise to include the missing clinical info.

Hint: The 50-year-old patient had a left inguinal hernia that was repaired with placement of mesh for this next case. Using your index and knowledge of modifiers will help you on Case 9!

Case # 9

PREOPERATIVE DIAGNOSIS: Left inguinal hernia.

POSTOPERATIVE DIAGNOSIS: Left inguinal hernia.

PROCEDURE PERFORMED: Repair of left inguinal hernia with placement of mesh.

ANESTHESIA: General anesthesia.


FINDINGS AT SURGERY: The 50-year-old patient had a left inguinal hernia that was repaired with placement of mesh. The patient tolerated the procedure quite well.

DESCRIPTION OF PROCEDURE: Under general anesthesia using an LMA, the patient?s left groin was prepped with ChloraPrep and then the appropriate sterile drapes were placed.

A standard skin incision was made and carried down through the dermis and Scarpa?s fascia to the external oblique which was opened in the direction of its fibers through the external ring. The cord structures were identified and were encircled with a Penrose drain. There was no direct hernia component found. There was mild laxity of the floor. The cord structures were skeletonized and a hernia sac was readily identified and cleared from the surrounding tissue down to the internal ring where the preperitoneal space was entered. The hernia sac was inverted into the preperitoneal space and a medium PerFix plug was placed in this area holding the inverted sac in very nicely. The mesh was tacked to the surrounding muscle layers using simple interrupted #0 Vicryl sutures. A sheet of mesh was then placed over the entire floor and held at the pubic tubercle and along the inferior aspect of the shelving edge of the inguinal ligament using a running #2-0 Prolene suture.

The tails of the mesh were then split around the internal ring and the superior tail was tacked down to the shelving edge again recreating the sling. The superior aspect of the mesh was held to the transposase fascia using simple interrupted #0 Vicryl sutures. At the end of this portion of the procedure, the entire floor was covered with mesh and there was absolutely no tension.

The wound was irrigated copiously with normal saline and then injected with 0.25% Marcaine with epinephrine. Closure consisted of reapproximation of the external oblique with a running #3-0 PDS suture followed by reapproximation of Scarpa?s fascia and the dermis with #4-0 Vicryl simple inverted interrupted sutures followed by reapproximation of the skin with a running subcuticular stitch of #5-0 Vicryl followed by Steri-Strips and a sterile dressing.

The patient tolerated the procedure quite well and was transferred to the recovery room in stable condition.

The sponge and needle counts were reported as correct at the end of the procedure.