General Surgery Coding Alert

Question: Our surgeon performed a laparoscopic recurrent right inguinal hernia repair, a right femoral hernia repair, and a laparoscopic left inguinal hernia repair. May I report all three procedures separately? New Mexico Subscriber Answer: Because the surgeon performed inguinal hernia repairs on opposite sides, you can report these procedures separately. But you must append modifiers LT (Left side) and RT (Right side), as appropriate, to differentiate among the procedures. In this case, you would report the recurrent right inguinal hernia using 49651-RT (Laparoscopy, surgical; repair recurrent inguinal hernia; right side) and the left inguinal hernia repair using 49650-LT (Laparoscopy, surgical; repair initial inguinal hernia; left side). In most cases, payers will bundle a femoral hernia repair to a recurrent inguinal repair on the same side because the surgeon uses the same piece of mesh to repair both the inguinal and femoral hernia. So, you wouldn't report the right femoral repair separately. Note: If the surgeon places a different piece of mesh for a femoral repair on the same side as the inguinal repair -- and the documentation clearly and specifically notes medical necessity for this approach -- you may report the laparoscopic femoral repair separately using 49659 (Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy) appended with modifier 59 (Distinct procedural service).