You Be the Coder:
Initial and Recurrent Hernias
Published on Thu Jun 01, 2000
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: A patient has two inguinal hernias repaired on the same day; one is recurrent and the other is initial. Do you use modifier -50 or modifier -51?
Oregon Subscriber
Answer: There are two separate codes for initial and recurrent inguinal hernia; therefore a modifier -50 (bilateral procedure) would not be appropriate, says Tammy Chidester, CPC, billing supervisor for Upshore Medical Management Services in Buckhammon, W.Va. A modifier -50 should be used only if exactly the same service was performed bilaterally. Modifier -51 is the correct modifier to use when multiple procedures are performed at the same session by the same physician.
For example, a surgeon has a patient older than 5 years of age and both hernias are reducible, the right side is initial and the left side is recurrent. You would use 49505-RT (repair initial inguinal hernia, age 5 years or over; reducible; right side) for the initial hernia and 49520-51-LT (repair recurrent inguinal hernia, any age; reducible; multiple procedures; left side) for the recurrent hernia. The RT (right) and LT (left) modifiers will help to keep your initial hernia from being denied as pre-existing. Make sure to code hernias according to these criteria: initial vs. recurrent, reducible vs. incarcerated or strangulated, and age of the patient.