Hellow fellow coders. I took the AAPC coding course & passed the test late in 2010. I work in a surgical practice and have been doing only office visit coding until this week (when our regular surgical coder went on vacation). Yikes! I am doing it, but I keep running into tons of questions.

Here is a case for you wise people:

From the op report I surmise these CPT codes:

1. open femoral hernia repair (49550 ?)
2. open right inguinal hernia repair with mesh (49505 ?)
3. ilioinguinal nerve block (01992 ?)

We use the Coding Today website to help us determine which CPT codes can/cannot be used together, and in what order.

In the bundling matrix CODING TODAY says about 49505:
"Modifier Required (49505 includes 49550)" and says that 49505 requires the use of a modifier.

1. Should I use 49505 (with a modifier) or just use 49550 alone (and NOT code 49505 at all)?

2. If I use 49505, which modifier should I use? 59? (our regular coder says 51 usually gets rejected so she usually uses 59 for multiple procedures)

3. Unsure how to code the “ilioinguinal nerve block.” The op report says that 10 cc of local was “injected into the right inguinal region” but there is no mention made of a nerve block as I understand it (i.e., a spinal nerve block). This is my ignorance showing. My best guess was 01992.

Anyway my GUESS about how to code is this:

49505 (with modifier 59)

I would appreciate your help! (I often get directed to these forums when I do Google searches for my office visit coding & get tremendous help from them -- but this is the first time I have ever posted a question here.) I have a day or 2 left before I must post this surgery, so I am looking forward to seeing the answers that come in.

Huge thanks to all!