Wiki INGUINAL HERNIA REPAIR

[CCANTER]

so i am kind of confused. The provider states the dx as nonreducible inguinal hernia. But i dont think its incarcerated or strangulated so would i use the following codes
CPT code 49505 with K4030. Not cpt code 49507

the lower abdomen and groin was prepped and draped in the standard fashion, and local anesthetic was used to anesthetize the skin over the mid-portion of the inguinal canal. An incision parallel to the inguinal ligament was made. Dissection was carried through the soft tissue to expose the inguinal canal and inguinal ligament along its lower edge. The external oblique fascia was split along the course of its fibers, exposing the inguinal canal. The ilioinguinal nerve was identified and transected sharply. The cord was looped using a Penrose drain and reflected out of the field. The defect was exposed and a piece of Phasix plug and patch kit was trimmed to size and placed under the defect. Vicryl suture was then used in a close the defect, with the suture being sewn from the pubic tubercle inferiorly and superiorly along the canal to a level just beyond the internal ring. Onlay mesh was split to allow passage of the cord and nerve into the canal without entrapment and sutured into place using vucryl. The contents were then returned to canal and the external oblique fashion was then closed in a continuous fashion using prolene suture taking care not to cause entrapment.

 

[nsteinhauser]

I would like to hear what others think about this one, and if any one has any documentation to back up their conclusions?
Since the 49505 definition in the CPT book says "reducible" after the 49505, I have always thought that if the hernia wasn't reducible, you would code the 49507, regardless of reason it was nonreducible..
An old CPT Asst from October 1994 states that incarcerated equals nonreducible: "Incarcerated Hernias: In medicine, incarcerated means the abnormal imprisonment of a part (ie, a hernia that is nonreducible). A nonreducible hernia is one that cannot be reduced by manipulation. In these types of hernias, the hernial contents are fixed in the hernial sac. The reasons these hernias have become nonreducible include incarceration, adhesion formation, and size of the hernia.
From the American College of Surgeons Bulletin in 2017, it states:
"A hernia should be considered incarcerated if, at the time of the operation, it contains viscera that the surgeon must manually reduce. It should be considered strangulated if the incarcerated contents have evidence of ischemia due to compression of the vascular supply." This says to be incarcerated, it has to contain viscera, or organ tissue, that the surgeon has to manually reduce. A lot of inguinal hernia sacs are filled with fat. Fat is not an organ, right?
If someone has documentation more recent than 1994 to settle "does non reducible equal incarcerated", or documentation that says "if a hernia is nonreducible, use 49507" please respond.