How To Use CPT Code 49540

CPT 49540 describes the repair of a lumbar hernia. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 49540?

CPT 49540 is used to describe the surgical repair of a lumbar hernia. This procedure involves making an incision over the hernia, identifying and dissecting the hernia further, ligating the herniated sac, and replacing it in the abdomen. The site is then closed with absorbable sutures, and a patch or mesh may be used for larger hernias. This code is used to report the surgical repair of a lumbar hernia.

2. Official Description

The official description of CPT code 49540 is: ‘Repair of lumbar hernia.’

3. Procedure

1. An incision is made over the hernia.
2. The hernia is identified and dissected further.
3. The herniated sac is ligated and replaced in the abdomen.
4. The site is closed with absorbable sutures.
5. A patch or mesh may be used for larger hernias.
6. Bleeding is controlled, and the incision is closed.

4. Qualifying circumstances

CPT 49540 is performed for patients with a lumbar hernia, which is a protrusion through the posterior abdominal wall in the area below the last rib. The hernia can occur through either the inferior lumbar triangle or superior lumbar triangle. This procedure is typically performed under general anesthesia. It is important to note that for bilateral procedures, modifier 50 should be used.

5. When to use CPT code 49540

CPT code 49540 should be used when performing a surgical repair of a lumbar hernia. It is important to ensure that the procedure performed matches the description provided by the code. This code should not be used for repairs of other types of hernias or for procedures that do not involve the repair of a lumbar hernia.

6. Documentation requirements

To support a claim for CPT 49540, the following documentation is required:

• Documentation of the patient’s diagnosis of a lumbar hernia
• Description of the procedure performed, including details of the repair and any additional techniques used
• Date of the procedure
• Start and end time of the procedure
• Any complications or unexpected findings during the procedure
• Signature of the performing surgeon

7. Billing guidelines

When billing for CPT 49540, ensure that the procedure performed matches the description provided by the code. Modifier 50 should be used for bilateral procedures. It is important to follow the specific billing guidelines provided by the payer to ensure accurate reimbursement. CPT code 49540 should not be reported with other codes that describe different procedures or repairs.

8. Historical information

CPT code 49540 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient undergoes a surgical repair of a lumbar hernia using CPT code 49540.
2. A surgeon performs a bilateral repair of lumbar hernias using CPT code 49540 with modifier 50.
3. A patient with a lumbar hernia undergoes a surgical repair with the use of a mesh, reported with CPT code 49540.
4. A surgeon performs a laparoscopic repair of a lumbar hernia using CPT code 49540.
5. A patient undergoes a surgical repair of a lumbar hernia with the additional closure of a fascial defect, reported with CPT code 49540.