General Surgery Coding Alert

GI Procedures:

Sort 13 Inguinal Hernia Repair Codes to 1 Correct Choice: Here’s How

Published on Thu Mar 17, 2022

See how adding hydrocele removal changes things.

If your heart sinks when you see an op report for an inguinal hernia repair, you’re not alone. With so many CPT^® codes for the procedure, plus bundling rules, choosing the proper code can seem daunting.

Help is here: Let our experts show you how to quickly cut through the code options to zero in on the one code you need for your case.

Definition: An inguinal hernia is a protrusion of abdominal contents through a weakness in the abdominal muscles located near the inguinal canal (in the groin region).

Step 1: Determine if Repair is Open or Laparoscopic

CPT^®provides just the following two codes for laparoscopic inguinal hernia repair:

49650 (Laparoscopy, surgical; repair initial inguinal hernia)
49651 (… repair recurrent inguinal hernia)

“You can see that the distinction between these two codes is whether this surgery is the initial repair of the inguinal hernia, or if someone has previously repaired it,” explains

Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, revenue cycle director for Clinical Health Network for Transformation in Houston, Texas.

Regardless of any other factors, such as the patient’s age or whether the hernia is reducible or not, you should choose either 49650 or 49651 for a laparoscopic inguinal hernia repair.

Step 2: Zero in on Codes for Recurrent Open Inguinal Hernia Repair

Similar to laparoscopic repair, CPT^®provides just the following two codes for recurrent open inguinal hernia repair:

49520 (Repair recurrent inguinal hernia, any age; reducible)
49521 (… incarcerated or strangulated)

The distinction between these two codes is whether the hernia is incarcerated or strangulated as opposed to reducible. You’d choose the same code regardless of the patient age, as the code states, “any age.”

Definitions: “Reducible” means that the abdominal contents protruding through the weakened abdominal wall can easily return within the abdominal wall with external pressure. Both incarcerated and strangulated hernias are not reducible, meaning that the tissue is “stuck” outside the abdominal wall. “A strangulated hernia is a life-threatening condition because the protruding tissue is pinched off from the blood supply,” Brame Joy says.

Step 3: Distinguish 8 Open Codes Based on Patient Age and More

When you’re coding for an initial open inguinal hernia surgery, you have eight codes to choose from. Patient age leads to four different code families, each distinguished based on whether or not the hernia is reducible.

For patients 5 years of age or older, turn to these codes:

49505 (Repair initial inguinal hernia, age 5 years or older; reducible)
49507 (… incarcerated or strangulated)

For patients 6 months up to 5 years old, turn to these codes:

49500 (Repair initial inguinal hernia, age 6 months to younger than 5 years, with or without hydrocelectomy; reducible)
49501 (… incarcerated or strangulated)

For infants up to 6 months old, or premature infants (born before 37 weeks gestation) who have passed 50 weeks since their birth, use one of these codes:

49495 (Repair, initial inguinal hernia, full term infant younger than age 6 months, or preterm infant older than 50 weeks postconception age and younger than age 6 months at the time of surgery, with or without hydrocelectomy; reducible)
49496 (… incarcerated or strangulated)

For preterm infants up through 50 weeks after birth these are the appropriate codes:

49491 (Repair, initial inguinal hernia, preterm infant (younger than 37 weeks gestation at birth), performed from birth up to 50 weeks postconception age, with or without hydrocelectomy; reducible)
49492 (… incarcerated or strangulated)

Step 4: Watch for Bundling Details

A careful reading of the preceding codes should have made you wonder about “hydrocelectomy.” You can see that codes 49491-49501 state “with or without hydrocelectomy.”

“Those are the codes for all for all open initial inguinal hernia repairs except for patients who are 5 years old or older,” says Brame Joy.

Definitions: A hydrocele is a fluid-filled sac surrounding a testicle that causes swelling in the scrotum. Hydroceles are common in newborn males, especially premature infants. However, hydroceles can also occur in older males during puberty and in adults. Surgery performed to repair or remove a hydrocele is a hydrocelectomy.

Oftentimes, hydroceles in newborn males will improve and resolve/ disappear spontaneously on their own as the connecting channel with the peritoneal cavity closes, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook. However, if the hydrocele doesn’t improve, the patient may need surgical intervention.

Don’t miss: A hydrocele commonly occurs with a hernia, and in pediatrics, the two are considered essentially the same. The mechanism and approach are the same to repair both hydrocele and hernia in infancy, so CPT^®bundles these procedures.

Older patients: A hydrocele may also form in older patients due to injury or other situations. When the surgeon repairs an inguinal hernia and a hydrocele in the same operative session for a patient 5+ years old, you should code the appropriate hernia code (49505 or 49507) plus a distinct code for the hydrocelectomy, which is 55040 (Excision of hydrocele; unilateral).

Step 5: All Bets Off for Sliding Hernia

Sliding inguinal hernias aren’t common. They’re formed when an organ such as the bladder or colon forms part of the hernia sac. But if you need to code an open inguinal hernia repair that involves a sliding hernia, you can forget about patient age, whether the hernia is reducible, or whether the patient had a prior repair.

Do this: CPT^®provides just one code for you to use in those cases: 49525 (Repair inguinal hernia, sliding, any age).

Tool: You can cut out the table on page 3 and save it for a quick reference to help you easily choose the right inguinal hernia repair code.