For epigastric hernias, 49570 and 49572, CPT requires a lateral modifier (50, RT or LT). However, this is a midline procedure, as confirmed by two of my docs (pediatric surgery/trauma). How do you code for this procedure?
Per two of my physicians, it's "midline". They didn't understand why I was asking for a laterality to begin with.Is the hernia unilateral or bilateral? From what I'm reading in my encoder edits, even if the incision if midline, you'd choose a modifier based on which side of the body the hernia was surgical worked on.
I would say if the hernia itself is 'midline' then it would be crossing into both right and left quadrants, leaving you with bilateral.Per two of my physicians, it's "midline". They didn't understand why I was asking for a laterality to begin with.
I do not have access to CPT Assistant. Do you happen to know if there is a CPT Assistant that addresses this?I would say if the hernia itself is 'midline' then it would be crossing into both right and left quadrants, leaving you with bilateral.
Where are you seeing that CPT requires a modifier - I haven't come across this. The procedure is allowed be done bilaterally, but that would be in a situation where there are two hernias, one one each side. But if it's a single mid-line hernia, I would not use a modifier. If it's one hernia, I would absolutely NOT use the 50 modifier for a midline as the post above suggests as that would cause an overpayment as it would reimburse for two procedures and that would definitely be incorrect.For epigastric hernias, 49570 and 49572, CPT requires a lateral modifier (50, RT or LT). However, this is a midline procedure, as confirmed by two of my docs (pediatric surgery/trauma). How do you code for this procedure?