How To Use CPT Code 49507

CPT 49507 describes the surgical repair of an inguinal hernia that is incarcerated or strangulated in patients aged 5 years or older. 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 49507?

CPT 49507 can be used to describe the surgical repair of an inguinal hernia that is incarcerated or strangulated in patients aged 5 years or older. This code is used when the provider performs the initial repair of the hernia, addressing the trapped or blood supply-cut off condition.

2. Official Description

The official description of CPT code 49507 is: ‘Repair initial inguinal hernia, age 5 years or older; incarcerated or strangulated.’

3. Procedure

1. The provider prepares the patient and administers anesthesia.
2. An incision is made in the groin area to access the incarcerated or strangulated bowel.
3. The provider carefully dissects the subcutaneous tissue and external oblique fascia, preserving the ilioinguinal nerve.
4. The neck of the hernia sac is released and opened to assess the contents.
5. If the contents are viable, the provider safely dissects nearby anatomy and reduces the hernia sac, returning it to its proper position.
6. If intestinal resection is necessary, it is separately reported.
7. The provider may place mesh to prevent hernia recurrence.
8. The external oblique fascia is closed, and the incision in the groin is closed.

4. Qualifying circumstances

CPT 49507 is used for the initial repair of an inguinal hernia that is incarcerated or strangulated in patients aged 5 years or older. It is important to note that this code is specific to the repair of the hernia and should not be used for recurrent hernias. Other codes are available for recurrent hernia repairs.

5. When to use CPT code 49507

CPT code 49507 should be used when the provider performs the initial repair of an inguinal hernia that is incarcerated or strangulated in patients aged 5 years or older. It is important to ensure that the patient meets the age requirement and that the hernia is properly documented as incarcerated or strangulated.

6. Documentation requirements

To support a claim for CPT 49507, the provider must document the following information:

• Patient’s age (must be 5 years or older)
• Description of the hernia as incarcerated or strangulated
• Details of the procedure, including the incision site and any additional procedures performed
• Use of mesh, if applicable
• Closure of the external oblique fascia and the incision

7. Billing guidelines

When billing for CPT 49507, ensure that the patient meets the age requirement of 5 years or older and that the hernia is properly documented as incarcerated or strangulated. It is important to note that CPT 49507 is specific to the initial repair of the hernia and should not be reported for recurrent hernias. Other codes are available for recurrent hernia repairs.

8. Historical information

CPT 49507 was added to the Current Procedural Terminology system on January 1, 1994. There was a code change on January 1, 2007, which updated the description of the code to specify the age requirement of 5 years or older.

9. Examples

1. A surgeon performs the initial repair of an incarcerated inguinal hernia in a 7-year-old patient.
2. A provider surgically addresses a strangulated inguinal hernia in a 65-year-old patient.
3. A surgeon performs the initial repair of an incarcerated inguinal hernia in a 12-year-old patient, using mesh for reinforcement.
4. A provider performs the initial repair of a strangulated inguinal hernia in a 50-year-old patient, with additional intestinal resection.
5. A surgeon performs the initial repair of an incarcerated inguinal hernia in a 30-year-old patient, using mesh for reinforcement.
6. A provider surgically addresses a strangulated inguinal hernia in a 70-year-old patient, with additional intestinal resection.
7. A surgeon performs the initial repair of an incarcerated inguinal hernia in a 20-year-old patient, using mesh for reinforcement.
8. A provider surgically addresses a strangulated inguinal hernia in a 55-year-old patient, with additional intestinal resection.
9. A surgeon performs the initial repair of an incarcerated inguinal hernia in a 40-year-old patient, using mesh for reinforcement.
10. A provider surgically addresses a strangulated inguinal hernia in a 60-year-old patient, with additional intestinal resection.