Wiki Two Umbilical Hernias...same session

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mdwyer

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Need some thoughts on this...

Physician did one incision to reduce an umbilical hernia and ended up finding two incarcerated supraumbilical hernias. He mentions that he amputates both and carries out closure in routine fashion.

Would you code 49587 once or would you code it twice?

Thanks for your help!
 
I would code it only once as per your description it was done through the same incision. If he had to make another incision, then I would code it twice with the 59 modifier. If the surgery took more time and was much more difficult you could try to bill with the 22 modifier, however the documentation in the note would need to specifically detail how much more labor intensive the procedure was and how much more time it took to perform the surgery.
 
Without having the Operative Note, I can only speculate to help you. If there was only one incision made for the 2 hernias to be repaired then, I would only code the CPT code once for this procedure. However, if the physician documented that he made a completely "separate" incision for the second repair, it would be within guidelines to code the second with a modifier -59 attached.

Hope this helps ;)
 
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