# recurrent or initial inguinal hernia??



## buppkl (Dec 10, 2010)

Pt taken to OR for repair of Inguinal hernia. Never any mention of prior repair. Doc indentified a prior direct inguinal hernia repair with mesh that seemed to be intact with no herniation through the repair. However he did see an indirect inguinal hernia lateral to the epigastric vessels with sac and preperitoneal contents. This was repaired with mesh. Would this be coded as an initial hernia since first time this particular hernia is being repaired or recurrent since second time hernia repaired in the inguinal area? Two coders with two different answers.


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## jettagirlfl (Dec 10, 2010)

I would say recurrent 49520


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## NaliniAAPC (Dec 10, 2010)

Hi,
I would also say its recurrent 49520 .How would you code as initial hernia repair...?

Regards,
Nalini CPC


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## preserene (Dec 10, 2010)

The first one was Direct I. Hernia and the one done now is the Indirect. Both are different by type, position and the site of occurrence and pathophysiologically point too.

The INDIRECT emerge out from deep inguinal ring and is the result of the failure of embryonic closure of the internal inguinal ring after the testis passés through it lateral to the inferior epigastric, covered by internal spermatic fascia and usually congenital.
The DIRECT(that was the previous surgical one)entered through a weak point(superficial inguinal ring) in the facia of the abdominal wall known as Hesselbach triangle, medial to the epigastric vessels, not covered by internal spermatic fascia and usual onset at adult age
The surgical procedure and the approach of entrance/ to get to the sac is also different in indirect hernia, though the incision was made for a suspected recurrent direct Hernia.

So I feel it is fair enough to say this is an Initial Indirect hernia Repair and you would assign as per strangulated or not.
Then for the procedure for recurrent Inguinal direct hernia Repair  you can report with another(as a second) CPT code with reduced service modifier, also appending -59 and a Vcode with V71.xx plus a detailed report from the surgeon indicating the whole scenario

Am I fair enough ? I do not know I am right or not Just trying to correlate  and analyse the medical necessity and assign the due coding.
Did you verify with your Surgeon?


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