How To Use CPT Code 49505

CPT 49505 involves the repair of an initial inguinal hernia in patients aged five years or older, with a reducible hernia. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 49505 procedures.

1. What is CPT 49505?

CPT 49505 is a medical billing code used to describe the surgical repair of an initial inguinal hernia in patients aged five years or older, with a reducible hernia. This code is used by medical coders and billers to accurately document and bill for this specific procedure.

2. 49505 CPT code description

The official description of CPT code 49505 is: “Repair initial inguinal hernia, age 5 years or older; reducible.”

3. Procedure

The CPT 49505 procedure involves the following steps:

1. The patient is prepped and anesthetized.
2. An incision is made in the groin at the site of the hernia.
3. The inguinal canal is exposed to identify the hernia sac.
4. The ilioinguinal nerve is identified and mobilized.
5. The spermatic cord, if present, is dissected free from the walls of the inguinal canal.
6. Finger pressure is applied in the inguinal region to reduce the hernia to the level of the fascial defect.
7. The internal ring, or opening of the inguinal canal, is closed.
8. The posterior, or back, wall of the inguinal canal is repaired.
9. The provider checks for bleeding, removes any instruments, and closes the incision.

4. Qualifying circumstances

Patients eligible to receive CPT code 49505 services are those aged five years or older with an initial inguinal hernia that is reducible. This means that the hernia can be pushed back into the abdominal cavity without causing further complications. Patients younger than five years or with non-reducible hernias may require different CPT codes for their hernia repair procedures.

5. When to use CPT code 49505

It is appropriate to bill the 49505 CPT code when a provider performs a surgical repair of an initial inguinal hernia in a patient aged five years or older, with a reducible hernia. This code should not be used for patients younger than five years or for those with non-reducible hernias, as different codes apply to these situations.

6. Documentation requirements

To support a claim for CPT 49505, the following information should be documented:

• Patient’s age and the reducibility of the hernia
• Preoperative diagnosis and indication for surgery
• Details of the surgical procedure, including the steps performed
• Postoperative diagnosis and any complications encountered
• Surgeon’s name and credentials
• Date and location of the procedure

7. Billing guidelines

When billing for CPT code 49505, keep in mind the following guidelines and rules:

• For hernia repair on both sides, apply modifier 50, Bilateral procedure.
• For a child between six months and five years of age, report CPT 49500, Repair initial inguinal hernia, age six months to younger than five years, with or without hydrocelectomy, reducible.
• CPT codes 49491 – 49557, 49600, 49605, 49606, 49610, 49611, 49650, and 49651 are unilateral procedures. For bilateral procedures, use modifier 50.

8. Historical information

CPT 49505 was added to the Current Procedural Terminology system on January 1, 1990. The code was changed on January 1, 2007, with the previous descriptor being “Repair initial inguinal hernia, age 5 years or over; reducible.”

9. Similar codes to CPT 49505

Five similar codes to CPT 49505 and how they differentiate are:

• CPT 49500: Repair of an initial inguinal hernia in patients aged six months to younger than five years, with or without hydrocelectomy, reducible.
• CPT 49507: Repair of an initial inguinal hernia in patients aged five years or older, with an incarcerated or strangulated hernia.
• CPT 49520: Repair of a recurrent inguinal hernia in patients aged five years or older, reducible.
• CPT 49525: Repair of an initial inguinal hernia with a sliding hernia component, age five years or older.
• CPT 49560: Repair of an initial ventral hernia, reducible.

10. Examples

Here are 10 detailed examples of CPT code 49505 procedures:

1. A 7-year-old patient with a reducible inguinal hernia undergoes surgical repair.
2. A 12-year-old patient with a reducible inguinal hernia and a hydrocele undergoes surgical repair of the hernia only.
3. An adult patient with a reducible inguinal hernia undergoes surgical repair using mesh.
4. A 6-year-old patient with bilateral reducible inguinal hernias undergoes surgical repair on both sides, with modifier 50 applied.
5. A 9-year-old patient with a reducible inguinal hernia undergoes surgical repair using a laparoscopic approach.
6. An adult patient with a reducible inguinal hernia and a history of a previous hernia repair undergoes surgical repair of the new hernia.
7. A 15-year-old patient with a reducible inguinal hernia undergoes surgical repair with local anesthesia.
8. An adult patient with a reducible inguinal hernia undergoes surgical repair with general anesthesia.
9. A 10-year-old patient with a reducible inguinal hernia undergoes surgical repair with a tension-free technique.
10. An adult patient with a reducible inguinal hernia undergoes surgical repair with a Shouldice technique.