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appy with hernia repair

  1. Exclamation appy with hernia repair
    Medical Coding Books
    Physician did lap appy with umbilical hernia repair. I know that the hernia repair is not separately billable unless a seperate incision is made... which it wasn't. So then he questions me if his appy can be billed with the -22 modifier, since he had to also perform the hernia repair, OR bill it with a -59 modifier instead of the -51 that was originally used. His office manager seems to think that since his notes mention "excess" preperitoneal herniation was resected and that a "large umbilical hernial sac" was found that this would be enough to use the -22 on the appy. This was already billed out to insurance with a -51 modifier appended to the hernia repair, and the hernia repair was denied as being part of the primary procedure.
    Here is the op note:

    With the patient in the supine position under adequate general endotracheal anesthesia, previous routine prep and drape of the abdomen, Foley catheter and SCDs in place, supraumbilical transverse incision is made through the skin and subcutaneous fat immediately finding a large umbilical hernial sac. This was dissected down to the fascia of the umbilicus around it and freed from the umbilical hernia. The excess preperitoneal herniation was resected. At this point, Veress needle was passed with a VersaStep sheath......

    That's all that is mentioned about the hernia repair. I could be wrong but it doesn't really seem like the documentation supports that this was anything but a basic hernia repair. Am I right, or should I go back and rebill the appy with the modifier -22?

  2. Default
    Gee, it doesn't sound to me like the documentation describes a whole lot of additional work--I don't think I would use modifier 22. It seems to me that he needs to get through this hernia to get to the appendix, which would be part of his approach. And since the hernia repair wasn't through a separate incision, I don't think you could justify modifier 59. If I was the coder, I wouldn't charge separately for the hernia repair.

    I hope this helps you out.


  3. Default
    Thanks... that was what I was thinking, but I wanted to get someone else's opinion too. I know they will fight me on this, but I just don't see the additional work there.

    Again... thanks!

  4. Default
    I agree with you both - the hernia rpr sounds "incidental" and in the current insurance environment, I don't believe the carrier would make any additional payment for it.
    C.Martin, CPC-GENSG

  5. #5
    What if you code the Umbilical hernia repair as primary and use the add on code 44955 for the appendectomy????

  6. #6
    I agree with Tinaval. I think the 49585 with the 44955 makes better sense and should result in additional revenue.

  7. Default
    It may depend upon what the original intent was. Just a thought.


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