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2 Hernias Same Side

  1. #1
    Default 2 Hernias Same Side
    Medical Coding Books
    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

  2. Default
    Quote Originally Posted by N70QW View Post
    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.

  3. #3
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    you may also need a 59 on the 2nd if the rt/lt solution does not work

  4. Default
    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.

  5. #5
    Location
    Milwaukee WI
    Posts
    4,466
    Default -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

  6. Default Hernia repair
    When billing 49505 bilaterally how do you enter the charge? 49505, 50 modifier, 2 units? Is this correct?

  7. #7
    Default
    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!

  8. #8
    Default
    Have you considered billing the 49505 twice and applying the 76 modifier to the second one?
    Last edited by TammyFarris; 03-17-2009 at 09:24 AM.

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