Wiki I need help with hernia questions

[melody.ongenae@gmail.com]

Can a spigelian hernia found during a robitic bilateral inguinal hernia repair be billed separately? There is not a separate incision the same mesh is used in the repair, the spigelian/ventral hernia is repaired during the planned 49650/50. Can the spigelian be billed/ paid? Should a 59 modifier be used? Or would it be inclusive like an umbilical hernia during the same procedure?

 

[melody.ongenae@gmail.com]

My biller tells me ACS replied to her, they can be billed together no modifier needed. Everything changed about coding hernias 2 years ago?

 

[AlisonFaught]

Yes, the codes for anterior abdominal hernia repairs changed in 2023. For professional billing, I do have to put a 59 modifier on the second procedure if an inguinal hernia repair is done at the same time - but only if it is a commercial insurance carrier, not for Medicare.