General Surgery Coding Alert

Question: A patient has repair of recurrent right inguinal hernia and initial left inguinal hernia with no obstruction or gangrene. What diagnosis codes would you use? 550.93 (inguinal hernia, without mention of obstruction or gangrene, NOS, bilateral, recurrent) for right, 550.92 (inguinal hernia, without mention of obstruction or gangrene, NOS, bilateral [not specified as recurrent]) for left; or 550.91 (inguinal hernia, without mention of obstruction or gangrene, NOS, unilateral or unspecified, recurrent) right and 550.90 (inguinal hernia, without mention of obstruction or gangrene, NOS, unilateral or unspecified [not specified as recurrent]) for the left? They were bilateral inguinal hernias, but only one was recurrent.

Louisiana Subscriber

Answer: Unfortunately, ICD-9 has a convention but not a code to designate this precise configuration, says Eric Sandham, CPC, compliance educator with Central California Faculty Medical Group, a group practice and training facility with the University of California at San Francisco in Fresno, Calif. There was no obstruction or gangrene on either, but only one side is recurrent. There is simply no way to specify which side has the recurrent hernia, and which the initial. You normally want to indicate the bilateral nature of the hernia using 550.9 with fifth digit 2 or 3. But the herniae are of different types and this is not an option, as coding bilaterally would lead one to believe that either both or neither are recurrent.

In this situation, the only accurate coding is to code them separately: 550.91 and 550.90 (code the recurrent first because it is slightly more complex). This also reflects their chronology of onset or treatment. If any CPT procedure codes for recurrent and initial repair are submitted, you might want to append the HCPCS modifiers -LT (left side) and -RT (right side) to indicate which side the recurrent hernia was on.