Our surgeon reported CPT codes 49505 and 49507 for repair of an initial inguinal hernia on the right and a strangulated initial hernia on the left. We put a modifier 51 on the second code, but the payor denied the service as bundled. Is this correct?
Answer:
No, it is not a correct denial. We recommend using modifier 59 instead of modifier 51 to indicate distinct separate services. The payor may think you attempted to reduce the hernia, it became strangulated, and you are trying to report two services for the same site. If the physician’s documentation supports both services, append a modifier 59 to CPT code 49505, repair reducible, initial hernia. It is correct to report both services, however Medicare has a CCI edit in place on this code combination. Append modifier 59 indicating that the repair of the incarcerated hernia was performed on the left, and the reducible hernia was on the right side.
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