If you read the description and notes for 49591, you should notice some issues with your use of 49591 x2.
49591 Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); less than 3 cm, reducible
Notes:
Codes
49591-
49618 describe repair of an anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian) by any approach (ie, open, laparoscopic, robotic). Codes
49591-
49618 are reported only once, based on the total defect size for one or more anterior abdominal hernia(s), measured as the maximal craniocaudal or transverse distance between the outer margins of all defects repaired. For example, "Swiss cheese" defects (ie, multiple separate defects) would be measured from the superior most aspect of the upper defect to the inferior most aspect of the lowest defect. In addition, the hernia defect size should be measured prior to opening the hernia defect(s) (ie, during repair the fascia will typically retract creating a falsely elevated measurement).
When both reducible and incarcerated or strangulated anterior abdominal hernias are repaired at the same operative session, all hernias are reported as incarcerated or strangulated. For example, one 2-cm reducible initial incisional hernia and one 4-cm incarcerated initial incisional hernia separated by 2 cm would be reported as an initial incarcerated hernia repair with a maximum craniocaudal distance of 8 cm (
49594).
Inguinal, femoral, lumbar, omphalocele, and/or parastomal hernia repair may be separately reported when performed at the same operative session as anterior abdominal hernia repair by appending modifier 59, as appropriate.
Codes
49621,
49622 describe repair of a parastomal hernia (initial or recurrent) by any approach (ie, open, laparoscopic, robotic). Code
49621 is reported for repair of a reducible parastomal hernia, and code
49622 is reported for an incarcerated or strangulated parastomal hernia.
Implantation of mesh or other prosthesis, when performed, is included in
49591-
49622 and may not be separately reported. For total or near total removal of non-infected mesh when performed, use
49623 in conjunction with
49591-
49622. For removal of infected mesh, use
11008.
1) 49591 specifies HERNIA(S). The notes state to report once with instructions about how to properly measure the 2 abdominal hernias.
2) 49591 also specifies REDUCIBLE, but your diagnosis states INCARCERATED
Hope that helps!