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.
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