How To Use CPT Code 49553

CPT 49553 describes the surgical repair of an initial femoral hernia that is incarcerated or strangulated. 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 49553?

CPT 49553 can be used to describe the surgical repair of an initial femoral hernia that is incarcerated or strangulated. This code is used when the provider surgically repairs the hernia, which occurs when abdominal contents, typically intestines, bulge through the canal carrying the femoral artery into the upper thigh. The hernia is considered incarcerated when it is trapped, and strangulated when the blood supply to the hernia is cut off.

2. Official Description

The official description of CPT code 49553 is: ‘Repair initial femoral hernia, any age; incarcerated or strangulated.’

3. Procedure

1. The provider prepares the patient and administers anesthesia.
2. An incision is made in the groin area.
3. The provider dissects the inguinal canal and femoral hernia sac from surrounding structures.
4. Adhesions, which are fibrous bands that form between tissues and organs, may be removed.
5. The provider opens the hernia sac to check the incarcerated or strangulated contents.
6. The extent of live tissue remaining in the hernia is identified.
7. If the contents are viable, the provider reduces the hernia sac, putting it back in its proper anatomical position.
8. If intestinal resection is necessary, it is separately reportable.
9. A mesh or patch graft may be placed over the defect to prevent recurrence.
10. The provider checks for bleeding, removes any instruments, and closes the incision in the groin.

4. Qualifying circumstances

CPT 49553 is used for the repair of an initial femoral hernia that is incarcerated or strangulated. It is important to note that this code is specific to the repair of an initial hernia. If the repair is performed on a recurrent femoral hernia that is incarcerated or strangulated, a different code should be used.

5. When to use CPT code 49553

CPT code 49553 should be used when the provider surgically repairs an initial femoral hernia that is incarcerated or strangulated. It is important to accurately document the details of the procedure to support the use of this code.

6. Documentation requirements

To support a claim for CPT 49553, the provider must document the following information:

• Patient’s diagnosis of an initial femoral hernia
• Description of the incarcerated or strangulated condition
• Details of the surgical repair procedure, including any additional services performed
• Use of mesh or patch graft, if applicable
• Any complications or unexpected findings during the procedure
• Signature of the provider performing the surgery

7. Billing guidelines

When billing for CPT 49553, ensure that the procedure meets the criteria for an initial femoral hernia repair that is incarcerated or strangulated. It is important to accurately document the details of the procedure to support the use of this code. Additionally, be aware of any modifiers that may be required for proper billing.

8. Historical information

CPT 49553 was added to the Current Procedural Terminology system on January 1, 1994. There have been no updates to the code since its addition.

9. Examples

1. A surgeon performs a surgical repair of an initial femoral hernia that is incarcerated in a 45-year-old patient.
2. A provider surgically repairs an initial femoral hernia that is strangulated in a 60-year-old patient.
3. A surgeon performs a surgical repair of an initial femoral hernia that is incarcerated in a 35-year-old patient, using a mesh to prevent recurrence.
4. A provider surgically repairs an initial femoral hernia that is strangulated in a 70-year-old patient, requiring extensive dissection.
5. A surgeon performs a surgical repair of an initial femoral hernia that is incarcerated in a 50-year-old patient, with additional intestinal resection required.
6. A provider surgically repairs an initial femoral hernia that is strangulated in a 55-year-old patient, using a patch graft to cover the defect.
7. A surgeon performs a surgical repair of an initial femoral hernia that is incarcerated in a 40-year-old patient, with complications encountered during the procedure.
8. A provider surgically repairs an initial femoral hernia that is strangulated in a 65-year-old patient, with unexpected findings of additional hernias.
9. A surgeon performs a surgical repair of an initial femoral hernia that is incarcerated in a 55-year-old patient, with the use of a mesh and additional services performed.
10. A provider surgically repairs an initial femoral hernia that is strangulated in a 50-year-old patient, with complications requiring additional interventions.