Q: I just wanted to clarify that with the new hernia repair codes, if a patient has a reducible and a strangulated hernia repaired at once, both would be coded as strangulated hernias?
A: That is correct. The guidelines state the hernia repair would be coded as strangulated in that situation.

Q: In the nephrolithotomy codes, when 50080 is performed on one side and 50081 is performed on the contralateral side would modifier 50 be reported?
A: No, modifier 50 would not be reported for bilateral procedure. This is stated in the guidelines for these codes. Coders would report the 50080 and 50081 with the appropriate laterality modifier for left and right.

Q: When the parenthetical notes in CPT instruct the coder to use -52 modifier for reduced services, is this appropriate for facility coding?
A: Modifier -52 is used on the facility side for procedures that do not require anesthesia. When a procedure requires anesthesia, facility coders would report modifier 73 for discontinued outpatient hospital procedure prior to the administration of anesthesia and 74 for discontinued outpatient hospital procedure after the administration of anesthesia.

Jennifer Cayce, RHIT, CCS, CCS-P, CPC, AHIMA Approved ICD-10-CM/PCS Trainer

Jennifer Cayce, RHIT, CCS, CCS-P, CPC, AHIMA Approved ICD-10-CM/PCS Trainer

Director of Coding Quality & Compliance

As a Director of Coding Quality & Compliance, Jennifer brings over 20 years of health information management, auditing, and coding experience to Haugen Consulting Group.

During her career, Jennifer has served as an inpatient and outpatient medical coder, lead coder, coding supervisor, auditor, and has developed training materials for multiple areas of HIM. Jennifer was integral in the development of web-based HIM education for coders, providers, clinical documentation improvement specialists, case managers, and patient access professionals.

During her time as a coding supervisor, Jennifer experienced a high success rate when appealing RAC and other external audit findings.

At the Haugen Consulting Group, Jennifer coordinates and leads the facility audit team and provides coding expertise and support to clients.

4 Comments

  1. Kim Sterling

    Can the size of the mesh inserted ( 6cm circle mesh) be used to determine the size of the hernia defect?

    Reply
    • kkluglein

      Hi Kim! Unfortunately, no. The guidelines specify the hernia measurement must be performed “either in the transverse or craniocaudal dimension. The total length of the defect(s) corresponds to the maximum width or height of an oval drawn to encircle the outer perimeter of all repaired defects. If the defects are not contiguous and are separated by greater than or equal to 10 cm of intact fascia, total defect size is the sum of each defect measured individually.”

      Reply
  2. Marie Thomas

    Jennifer,
    In the webinar, the inpatient prolonged service code 99418 was given. In the AMA guidelines, 993×0 is given. Please help us understand which is appropriate to use.
    I tried to copy/paste the AMA reference, but this platform would not allow adding any material. thank you; mt

    Reply
    • kkluglein

      Hi Marie,
      The AMA used 993×0 as a placeholder before the code set was officially published. The code is 99418.

      Reply

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