How To Use CPT Code 49500

CPT 49500 describes the repair of an initial inguinal hernia in children between the ages of six months and five years, with or without hydrocelectomy. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 49500?

CPT 49500 can be used to describe the repair of an initial inguinal hernia in children between the ages of six months and five years. This code may also include the excision of a hydrocele, which is a swelling in the scrotum.

2. Official Description

The official description of CPT code 49500 is the repair of an initial inguinal hernia, reducible type, in children between the ages of six months and five years, with or without hydrocelectomy.

3. Procedure

1. The provider begins by making an incision in the groin at the site of the hernia.
2. They then expose the inguinal canal to identify the hernia sac.
3. Using hand pressure, they push back the hernia to the level of the fascial defect.
4. If a hydrocele is present, the provider incises it and removes the fluid from the scrotal sac.
5. The hernia defect is repaired using absorbable sutures, and the inguinal canal is reconstructed.
6. The provider checks for bleeding, removes any instruments, and closes the incision.

4. Qualifying circumstances

CPT 49500 is used for the repair of an initial inguinal hernia in children between the ages of six months and five years. It may also include the excision of a hydrocele. This procedure is typically performed on a reducible hernia, where the provider can push back the protrusion using hand pressure.

5. When to use CPT code 49500

CPT code 49500 should be used when a provider performs the repair of an initial inguinal hernia in children between the ages of six months and five years. It is important to note that this code is specifically for reducible hernias and may or may not include the excision of a hydrocele.

6. Documentation requirements

To support a claim for CPT 49500, the provider must document the following information:

• Patient’s age and diagnosis of an initial inguinal hernia
• Details of the procedure performed, including any additional procedures such as hydrocelectomy
• Incision site and size
• Findings during the procedure, such as the presence of a hernia sac or hydrocele
• Repair technique used and any materials or sutures utilized
• Any complications or unexpected events during the procedure
• Postoperative care instructions and follow-up plans

7. Billing guidelines

When billing for CPT 49500, ensure that the procedure is performed on children between the ages of six months and five years and involves the repair of an initial inguinal hernia. If a hydrocelectomy is also performed, it should be documented and billed accordingly. Modifier 50 should be used to indicate a bilateral procedure if applicable. It is important to review the specific billing guidelines of the payer to ensure accurate coding and reimbursement.

8. Historical information

CPT 49500 was added to the Current Procedural Terminology system on January 1, 1990. There was a code change on January 1, 2007, which revised the description of the code.

9. Examples

1. A six-month-old infant undergoes a repair of an initial inguinal hernia without hydrocelectomy.
2. A four-year-old child has a repair of an initial inguinal hernia with the excision of a hydrocele.
3. A three-year-old toddler undergoes a repair of a recurrent inguinal hernia without complications.
4. A five-year-old child has a repair of a recurrent inguinal hernia with hydrocelectomy.
5. A two-year-old infant undergoes a repair of an initial inguinal hernia with the excision of a hydrocele.
6. A four-year-old child has a repair of a recurrent inguinal hernia without complications.
7. A six-month-old infant undergoes a repair of an initial inguinal hernia without hydrocelectomy.
8. A three-year-old toddler has a repair of an initial inguinal hernia with the excision of a hydrocele.
9. A five-year-old child undergoes a repair of a recurrent inguinal hernia without complications.
10. A two-year-old infant has a repair of a recurrent inguinal hernia with hydrocelectomy.