What is the CPT (Current Procedural Terminology) code for inguinal hernia repair?

CPT Codes for Inguinal Hernia Repair

The appropriate CPT code for inguinal hernia repair depends on the specific surgical approach used, patient age, and whether the hernia is reducible or incarcerated/strangulated.

Primary CPT Codes for Inguinal Hernia Repair

Open Approach

• 49505: Initial inguinal hernia repair, age 5 years or older; reducible
• 49507: Initial inguinal hernia repair, age 5 years or older; incarcerated or strangulated
• 49500: Initial inguinal hernia repair, age less than 5 years; reducible
• 49501: Initial inguinal hernia repair, age less than 5 years; incarcerated or strangulated
• 49520: Repair of recurrent inguinal hernia, any age; reducible
• 49521: Repair of recurrent inguinal hernia, any age; incarcerated or strangulated

Laparoscopic Approach

• 49650: Laparoscopic initial inguinal hernia repair, reducible
• 49651: Laparoscopic repair of recurrent inguinal hernia

Factors Affecting CPT Code Selection

The selection of the appropriate CPT code is determined by several key factors:

1. Patient age: Different codes apply for patients under 5 years versus 5 years and older 1
2. Surgical approach: Open (anterior) versus laparoscopic (TAPP or TEP) 1, 2
3. Hernia status: Whether the hernia is reducible or incarcerated/strangulated 1, 3
4. Initial versus recurrent: Different codes apply for initial repairs versus recurrent hernia repairs 1

Coding Considerations

• When bilateral inguinal hernias are repaired during the same operative session, append modifier -50 to the appropriate CPT code
• For laparoscopic repair of bilateral inguinal hernias, report the appropriate code (49650 or 49651) with modifier -50
• If mesh is used during the repair, this is included in the CPT code and not coded separately 1

Clinical Decision-Making for Repair Technique

The surgical approach selection impacts the CPT code and should be based on:

• Patient factors: Age, comorbidities, and anticoagulant use significantly influence the surgical approach, with patients ≥65 years more likely to undergo open repair 4
• Hernia characteristics: Size, location (inguinoscrotal extension), and whether it's recurrent 3
• Surgeon expertise: The Lichtenstein and other open tension-free techniques are easier to teach and replicate at all levels 5

Documentation Requirements

For accurate CPT coding, surgical documentation should clearly specify:

• Patient age
• Whether the hernia is initial or recurrent
• Whether the hernia is reducible or incarcerated/strangulated
• Surgical approach used (open or laparoscopic)
• Unilateral versus bilateral repair
• Any complications encountered during the procedure

Remember that proper documentation is essential for appropriate code selection and reimbursement for inguinal hernia repair procedures.