Louisiana Subscriber
Answer: If the urologist performs a hernia repair on one side, and explores the other side but doesn't find a hernia, use 49505 (Repair initial inguinal hernia, age 5 years or over; reducible) with modifiers -50 (Bilateral procedure) and -52 (Reduced services) appended. Reimbursement will probably be 110-120 percent, not the full 150 percent of 49505.
If the hernia is strangulated or incarcerated, bill 49507 ( incarcerated or strangulated) with appropriate modifiers depending on exploration of the contralateral side.