tci General Surgery Coding Alert - 2003 Issue 2

Reader Question: Use Modifier -50 on Most Bilateral Hernias

Question: I've heard conflicting advice on whether I should append modifier -50 to hernia repairs. May I use modifier -50 for repair of bilateral inguinal hernia? Montana SubscriberAnswer: Modifier -50 (Bilateral procedure) is appropriate for most types of hernia repair except umbilical (49580-49587 and 49600-49611) and hiatal (39502-39541). Therefore, you may report modifier -50 for repair of bilateral inguinal hernia (49491-49525). The operative note should make clear that the repair occurred on both sides. Generally, the payer will increase reimbursement with modifier -50 to 150 percent of the usual fee (for example, if a unilateral surgery pays $200, the...

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