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?
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Wiki Epigastric hernias
- Thread starter lynngilmore@gmail.com
- Start date
OpenClaims
Guest
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.
Per two of my physicians, it's "midline". They didn't understand why I was asking for a laterality to begin with.
OpenClaims
Guest
I would say if the hernia itself is 'midline' then it would be crossing into both right and left quadrants, leaving you with bilateral.
I do not have access to CPT Assistant. Do you happen to know if there is a CPT Assistant that addresses this?
thomas7331
Guest
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.