inguinal hernia repair cpt code

Inguinal Hernia Repair CPT Code (2022) Description, Guidelines, Reimbursement, Modifiers & Examples

Inguinal Hernia Repair CPT Code(s) 49495-49557 bills for service when the physician performs initial or recurrent inguinal hernia repair of reducible, incarcerated, or strangulated on infants younger than six months or from 6 months to 5 years old or any age with or without hydrocelectomy

Inguinal Hernia Repair CPT Code Description

The physician performs surgery on an infant or adult to repair a groin hernia. It may comprise fluid drainage that accumulated around the hydrocele

The physician repairs an initial, reducible, inguinal hernia in a full-term infant under six months or a preterm infant over 50 weeks post-conceptual age and under six months at the time of surgery, with or without hydrocelectomy.

The physician examines the pre-peritoneal axis to determine the hernia ring. They may apply manual pressure to the inguinal hernia from the outside of the body while performing reducible hernia. 

The physician may make an unsuccessful attempt due to the varying size of the hernia compared to the contents. They may perform an incision and enlarge the hernia ring by electrocautery in a ventral direction.

The incision makes in a ventral to the medial direction for medial hernias and a ventrolateral direction for lateral hernias. The hernia reduces using pleural insufflation of carbon dioxide. 

The physician may incise or drain the hydrocele if present. Sutures apply to the defected hernia and may staple or mesh by force. 

Report different codes when the physician performs incarcerated or strangulated hernia. In this case, the physician empties the hernia sac contents, places the contents in the lower abdomen, and repairs the hernia defect by suture.

CPT 49495

Inguinal Hernia Repair CPT Code 49495 bills for service when the physician performs initial inguinal hernia repair of Infants younger than age six months or preterm infants older than 50 weeks post-conception age and fewer than six months age at the time of surgery. It may perform with or without hydro-celectomy; reducible

repair inguinal hernia cpt code

CPT 49496

CPT 49496 bills for service when the physician performs initial inguinal hernia repair of Infants younger than age six months or preterm infants older than 50 weeks post-conception age and fewer than six months age at the time of surgery. It may perform with or without hydrocelectomy, be incarcerated, or be strangulated.

cpt code for inguinal hernia repair

CPT 49500

Inguinal Hernia Repair CPT Code 49500 bills for service when the physician performs initial inguinal hernia repair, age six months to fewer than five years, with or without hydrocelectomy; reducible

open inguinal hernia repair cpt code

CPT 49501

CPT 49501 bills for service when the physician performs initial inguinal hernia repair, age six months to fewer than five years, with or without hydrocelectomy; incarcerated or strangulated

bilateral inguinal hernia repair cpt code

CPT 49505

Inguinal Hernia Repair CPT Code 49505 bills for service when the physician performs initial inguinal hernia repair, age five years or older; reducible

TIP: You can find the complete billing guide for CPT 49505 here.

CPT 49505

CPT 49507

CPT 49507 bills for service when the physician performs initial inguinal hernia repair age five years or older; incarcerated or strangulated

CPT 49507

CPT 49520

CPT 49520 bills for service when the physician performs recurrent inguinal hernia repair at any age; reducible

CPT 49520

CPT 49521

Inguinal Hernia Repair CPT Code 49521 bills for service when the physician performs recurrent inguinal hernia repair at any age; incarcerated or strangulated

CPT 49521

CPT 49525

CPT 49525 bills for service when the physician performs recurrent inguinal hernia repair, sliding, any age

CPT 49525

Inguinal Hernia Repair CPT Code Reimbursement

A maximum of one unit can be a bill on the same service date of Inguinal Hernia Repair CPT Code(s) 49495-49521. In contrast, the Two units allow documentation supporting the service’s medical necessity.

The cost and RUVS of CPT 49495 are $447.63 and 12.93495 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 49495 are $447.63 and 12.93495 when performed in the non-facility.

The cost and RUVS of CPT 49496 are $674.39 and 19.48757 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 49496 are $674.39 and 19.4875 when performed in the non-facility.

The cost and RUVS of CPT 49500 are $459.31 and 13.27261 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 49500 are $459.31 and 13.27261 when performed in the non-facility.

The cost and RUVS of Inguinal Hernia Repair CPT Code 49501 are $663.96 and 19.18630 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 49501 are $663.96 and 19.18630 when performed in the non-facility.

The cost and RUVS of CPT 49505 are $573.15 and 16.56194 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 49505 are $573.15 and 16.56194 when performed in the non-facility.

The cost and RUVS of CPT 49507 are $642.63 and 18.56993 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 49507 are $642.63 and 18.56993 when performed in the non-facility.

The cost and RUVS of CPT 49520 are $691.44 and 19.98020 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 49520 are $691.44 and 19.98020 when performed in the non-facility.

The cost and RUVS of CPT 49521 are $779.86 and 22.53517 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 49521 are $779.86 and 22.53517 when performed in the non-facility.

The cost and RUVS of Inguinal Hernia Repair CPT Code 49525 are $627.51 and 18.13279 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 49525 are $627.51 and 18.13279 when performed in the non-facility.

Inguinal Hernia Repair CPT Code Modifiers 

The following are the list modifiers applicable with Inguinal Hernia Repair CPT Code(s) 49495-49521 :   

22, 23, 47, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79, 80, 81 82, 99, , AS, CC, CR, ET, EY, GA, GC, GK, GR, GU, GY, GZ, KX, Q5, Q6, QJ, SG, TC, XR, XP, XU, XS, AI, AQ, AR.     

Modifier 47 is applicable CPT 49495-49521 when the surgeon administers general or regional anesthesia to the patient. It is not appropriate to report modifier 47 with anesthesia procedures.  

Modifier 76 is appropriate with CPT 49495-49521 when a similar service performs by the Same Physician on the same service date.   

Modifier 54 is applicable with Inguinal Hernia Repair CPT Code(s) 49495-49521 when the physician provides surgical care only. In contrast, Modifiers 55 and 56 attach to CPT 49495-49521 when the physician performs post-management and pre-operative care only.   

Modifier 76 is applicable with CPT 49495-49521 when a similar service performs by a different Physician on the same service date.   

Modifier 59 is applicable with CPT 49495-49521 when a Distinct service performs by the physician and bundled with another procedure on the same date.     

 Modifier X {E, P, S, U} is applicable instead of Modifier 59 with CPT 49495-49521 when service bills to Medicare insurance. It divides the modifier into four parts for further specification of the procedure.   

Modifier 53 will be reported with CPT 49495-49521 if an unsuccessful attempt for an inguinal hernia repair makes due to unavoidable circumstances like allergic reactions to the substance.   

Modifier 22 applies to Inguinal Hernia Repair CPT Code(s) 49495-49521 when services perform longer than usual and take extra resources during the procedure.   

Modifier 23 is applicable with CPT 49495-49521 when general or local anesthesia administers by the physician and routinely does not require during the procedure.   

Modifier 52 applies when the physician does not complete the inguinal hernia repair service and terminates due to unavoidable circumstances.   

If physicians believe that Medicare will deny such service, reporting with a GA modifier is appropriate. The beneficiary must sign an Advance Beneficiary Notification (ABN), and CPT 49495-49521 must apply the GA modifier to that service.

Inguinal Hernia Repair CPT Code Billing Guidelines

Documentation should support the medical necessity of service. It reflects that service is medically necessary and appropriate.  

The following are ICD 10 Payable Dx codes when Inguinal Hernia Repair CPT Code(s) 49495-49521 performs:

  • K40.20, K40.90, N43.0, N43.2, N43.3, P83.5

The Inguinal hernia repair includes Initial repair: no previous repair is required, mesh or other prostheses, recurrent repair, needed last repair(s). 

The Inguinal hernia repair includes Hernia repairs done on preterm infants older than 50 weeks post-conception age and younger than six months.

If Abdominal wall debridement (11042, 11043) performs in conjunction with inguinal hernia repair, it is appropriate 11042, 11043 separately with appropriate modifier when required.

Intra-abdominal hernia repair/reduction (44050) performs with inguinal hernia repair. It is appropriate 44050 separately with a proper modifier when required.

Code also repairs or excision testicle(s), intestine, and ovaries when performed (44120, 54520, 58940) in combination with inguinal hernia repair, report with modifier if appropriate.

CPT code 49495-49521 has 90 days global period. If any Evaluation and management (E/M) service perform in conjunction with CPT code 66984, modifier 24 will report with E/M service for an unrelated condition. 

 Suppose the E/M visit is for post-operative care of a prior surgical procedure. In that case, it is not appropriate to report the E/M code with 49495-49521 separately during the global period time. While modifier 25 will be applicable with CPT code 49495-49521 if the patient sees for an unrelated condition on the same date of the procedure. 

Inguinal Hernia Repair CPT Code Example

The following are the example of when physicians perform inguinal hernia repair:

Sample Operative Report

Date/Time:  Dec XX, 2022 

Procedure(s) Performed:      Robotic left incarcerated Inguinal hernia with the urinary bladder into the Supasac reinforced with Mesh. 

Pre-Operative Diagnosis:      Symptomatic Inguinal hernia partially incarcerated 

Post-Operative Diagnosis:      Incarcerated Inguinal hernia with the sleeping of the urinary bladder into the Supasac through the Hesselbach triangle 

Primary Surgeon Surgeon (s):      Dr. ABC Assisted by: Dr. XYZ Anesthesia Type: General well-tolerated 

Justification for Procedure: This patient saw in my office with a chief complaint of a bulging mass in the left groin region, the testicle, and when standing up, she was partially incarcerated and partially of Cord reducible very symptomatic patient discussed diagnosis alternative treatment risk and benefits there is a scar in the right Umbilical area which reveals possible previous surgical repair of the right Inguinal hernia patient does not remember what kind of surgery he had—the patient schedules for robotic Inguinal hernia repair, possibly open and reinforced with Mesh. Still, the incision position would be for a Right Inguinal hernia repair with the Open technique. 

Inguinal Hernia Repair CPT Code Description of Procedure(s): 

The patient intubates and placed in the supine position under general anesthesia. Abdomen prepped and draped with ChloraPrep in the usual fashion. 

Timeout conducts appropriately. 

The operation starts with the patient in reverse Trendelenburg. The Right lateral inclination replaces the Veress needle in the left upper quadrant to obtain pneumoperitoneum up to 15 mmHg with CO2 in place in the left position for the left-hand trocar.

A 5 mm trocar and a lens under vision administer into the peritoneal cavity with the Optiview. We put them right in the middle trochars for the right hand and the camera 30 degrees up.

We had the three trochars safely placed in the abdomen, put the patient in Trendelenburg, lowered the table, and corrected the inclination to 0 positions. 

The excited robotic platform then docks appropriately with a 30-degree camera. It performs with the help of the Left hand with a fenestrated grasper and bipolar energy in the right hand, scissors, and monopolar energy. 

The operation was started by declots sedating the Supasac over the direct hernia near the midline. The urinary bladder slipped into it. The sac and the bladder pull out.  

The surgeon opens the peritoneum above the defect, exposing the capsule back triangle and Cooper’s ligament.

The surgeon develops a flap of the peritoneum. Above the fault by opening from the medial to lateral the parietal peritoneum. 

Once the urinary bladder removes out of the incarcerated position, the lipoma also mobilizes to expose the transversalis fascia defect was closed with a running suture of nonabsorbable V-Loc suture; 

Then, we made room for the medium size left-sided Davol lightweight mesh inspection of the Cord revealed no indirect Inguinal hernia. We placed a placental membrane on top of the Cord, and the Umbilical nerve set the Mesh to cover the defect sutured to Cooper’s ligament with an interrupted suture of 0 Prolene 

And then will suture lateral to the epigastric and medial to it with interrupted sutures of 2-0 Prolene. It fixes the Mesh in a geographic position to protect the indirect and then direct repair. 

All trochars removed under vision CO2 were evacuated from the peritoneal cavity. The peritoneal flap was then closed with a running suture of absorbable V-Loc 2 0 needle count sponge count, and instrument count where correct blood loss was minimal 1 to 2 mL. There was absolutely no indication of any injury to the hollow viscus. The skin approximates intradermic 4-0.

Finding(s):      As above 

Complications: None 

Specimens Removed.      

None Implants/Explants: Medium size left side Davol lightweight mesh for Umbilical repair Estimated Blood Loss:      1 to 2 mL 

Patient Condition:      Good

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