# Inguinal and femoral hernia



## ms123 (Nov 21, 2013)

I have a laparoscopic inguinal repair (49650 RT) where they repaired the hernia with mesh.  While in there, the physician documents the following:  The dissection was carried out, reducing the indirect hernia and separating the round ligament from the iliac vessels.  A small FEMORAL hernia was also discovered and reduced. This was containing fatty tissue.  A double mesh repair was performed using 2 separate polypropylene mesh patch prostheses.  The first mesh was cut with a lateral slit inserted in position *covering all the hernia orifices.* THe second was then placed overtop."

My question is can I also code the femoral hernia repair 49659 (herniorrhaphy laparoscopic) as there is no femoral laparoscopic hernia repair code.  Thank so much.


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## pennynance@bellsouth.net (Nov 21, 2013)

I think I would most likely bill the lap repair and use a 22 modifier if your surgeon documented excess time above the normal time for the initial repair. I believe it would be easier to make a case for additional time than for an unlisted procedure.


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## ms123 (Nov 21, 2013)

This is in an ASC so we do not use the 22 modifier.  This is a BC patient.  In this instance would you code the femoral hernia separately based on the above op report?  Thanks so much for your reply.


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## pennynance@bellsouth.net (Nov 21, 2013)

we do alot of our procedures with my surgeon at an ASC and I have spoken with their coder to see if I can help you out. My thoughts were to not bill the femoral since it was incidental and the same mesh was used to cover all orifices. However, if you decide to bill the unlisted code send records explaining your case and see what the outcome is... all they can do is say no... you may also speak with the surgeons  coder and see how they are going to bill it. Sorry I know that isnt alot of help


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## bertll (Jul 21, 2014)

Did you end up billing both?  If so did they both get paid?  I have the same scenario and am just wondering what you may have found.


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