ED Coding and Reimbursement Alert

Question: Since there is no code for manual reduction of an inguinal hernia, is it appropriate to append modifier -52 on a surgical procedure code such as 49496 or 49495. Should I only use modifier -52 when the physician eliminates part of the procedure? If -52 isn't correct here, should I just include the procedure in the E/M code?
    
Texas Subscriber Answer: Your best bet here is to roll the physician's work on the inguinal hernia into the evaluation and management (E/M) code (99281-99285). If he administered parenteral narcotics, that would satisfy the requirement for "high" risk and justify reporting a fairly high-level E/M code.
 
You shouldn't report a procedural code for this service, even with modifier -52 (Reduced services). There isn't much relation between either code 49495 (Repair, initial inguinal hernia, full term infant under age 6 months, or preterm infant over 50 weeks postconception age and under age 6 months at the time of surgery, with or without hydrocelectomy; reducible) or 49496 (...incarcerated or strangulated) and the manual reduction of an inguinal hernia in the emergency department under conscious sedation. These codes describe the open treat-ment and repair of a hernia defect in the operating room.