Wiki 2 Hernias Same Side

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N70QW

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I don't code surgery very often so I am hopeing someone can help with this one. The pt has an intial right inguinal hernia 49505 and an incarcerated left
inguinal hernia, 49507-51. THis claim is for Medicare and I keep getting it denied for M80 reason code which states basically unbundling. Any suggestions? I am not sure how to bill it bilaterally where they are two different types of hernias. Thanks
 
N70QW said:
I don't code surgery very often so I am hopeing someone can help with this one. The pt has an intial right inguinal hernia 49505 and an incarcerated left
inguinal hernia, 49507-51. THis claim is for Medicare and I keep getting it denied for M80 reason code which states basically unbundling. Any suggestions? I am not sure how to bill it bilaterally where they are two different types of hernias. Thanks
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Hi,
Please try and append LT to 49507 and RT to 49505; No need 51 modifier.
I guess both 49505 and 49507 should be coded-as two surgical incisions-two separate codes can be rendered.
 
hello,
Even the dx should be different for both CPTs.
550.90 for the right inguinal hernia
550.10 for the left hernia, that is incarcerated.
With separate Dxs, a 59 modifier is not mandatory.
 
-59 modifier

I would probably use the -59 modifier ... but Lavanya has a good point re differing diagnoses. Be sure to link them appropriately.

F Tessa Bartels, CPC, CPC-E/M
 
I would not bill with the 50 modifier. This will deny. I would code it as 49507 w/dx 550.10 and 49505-59 w/dx 550.90 ( I assume 49507 is more expensive). I would attach a modifier note with an explanation of the billing and the op report. I did coding for an ASC and this is what I did in the past and it should pay. I would make sure the documentation supports the billing!
 
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