hernia procedures and mod 59 - I have a provider billing

chaveje

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I have a provider billing
49505 Repair initial inguinal hernia, age 5 years or older; reducible
49585 Repair umbilical hernia, age 5 years or older; reducible
The issue of appending 59 vs 51 has come up. Why would 59 modifier be more appropriate to use in this situation than a 51?
These codes are not bundled?
Thank you
 

mbort

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If you are coding for the surgeon, then the 51 is appropriate on the 2nd procedure. There is no need for the 59 modifier.
 

ramcpc

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Dear Member,

As per NCCI-Edits, 49505 and 49585 can be billed together. Hence no need to add 59 Modifier but we need to differentiate the service to reimburse both the procedures we need to add Mod 51. This is more appropriate.

Thanks,
B.T.RamKumar, MBA, CPC.
 
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