from coding coach med assests
HERNIA REPAIR is discussed in the Winter of 1994 CPT Assistant, which states: “The HERNIA REPAIR codes in this section are categorized primarily by the type of HERNIA (inguinal, femoral, incisional, etc.). Some types of hernias are further categorized as “initial” or “recurrent” based on whether or not the HERNIA has required previous REPAIR(s). Additional variables accounted for by some of the codes include patient age and clinical presentation (reducible vs. incarcerated or strangulated). With the exception of the incisional HERNIA REPAIRs (see 49560 49560 49561 49565 - 49566) the use of MESH or other prostheses is not separately reported. The excision/REPAIR of strangulated organs or structures such as testicle(s), intestine, ovaries are reported by using the appropriate code for the excision/REPAIR (eg, 44120, 54520, and 58940) in addition to the appropriate code for the REPAIR of the strangulated hernia. (For reduction and REPAIR of antra-abdominal hernia, see 44050) (For debridement of abdominal wall, see 11042, 11043) (All codes for bilateral procedures in HERNIA REPAIR have been deleted. To report, add modifier -50 or 09950)… The use of MESH or other prosthesis is reported only with the incisional HERNIA REPAIR codes 49560 - 49566. Although MESH or other prosthesis may be used to REPAIR other types of hernias, code 49568 is only reported with the incisional HERNIA REPAIR codes.” HERNIA REPAIR is also addressed in chapter 6 of the CCI Manual, specifically under section D “Digestive System', which states: “If a HERNIA REPAIR is performed at the site of an incision for an open abdominal procedure, the HERNIA REPAIR is not separately reportable. The HERNIA REPAIR is separately reportable if it is performed at a site other than the incision and is medically reasonable and necessary. An incidental HERNIA REPAIR is not medically reasonable and necessary and should not be reported separately. When a recurrent HERNIA requires REPAIR, the appropriate recurrent HERNIA REPAIR code is reported. A code for incisional HERNIA REPAIR is not to be reported in addition to the recurrent HERNIA REPAIR unless a medically necessary incisional HERNIA REPAIR is performed at a different site. In this case, modifier -59 should be attached to the incisional HERNIA REPAIR code.” The HERNIA series of CPT code descriptions (CPT 49491-49590) do not mention coding multiple hernias for the same anatomical site. Therefore, based upon the above guidelines, it appears only one HERNIA REPAIR is reported, unless a different REPAIR is performed at a different anatomical site, as supported by your facility documentation. If two or more hernias are REPAIRed at different anatomical site(s), append modifier 59 to the additional HERNIA REPAIR code(s). As a note, the above resources provide instructions to report additional codes when there is "excision/REPAIR of strangulated organs or structures such as testicle(s), intestine, ovaries.” These procedures “are reported by using the appropriate code for the excision/REPAIR (eg, 44120, 54520, and 58940) in addition to the appropriate code for the REPAIR of the strangulated hernia.”
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