CPT Coding for Open Inguinal Hernia Repair

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Types of Inguinal Hernias

Not all inguinal hernias are alike. There are several variables by which an inguinal hernia is classified.

Key Terms

• Initial: An inguinal hernia that has not undergone primary repair.
• Recurrent: Reappearance of an inguinal hernia directly related to the primary repair of an initial hernia. Causes include wound infection, improper healing or inadequate primary repair.
• Reducible: The contents of the hernia can be manually returned to their proper place within the abdominal cavity.
• Incarcerated/strangulated: Incarceration is when the contents of the hernia get trapped in the hernia sac and cannot be returned to the abdominal cavity. Incarceration can lead to swelling or pain. Incarceration that compromises the blood supply to the hernia contents is called strangulation.
• Sliding: A hernia in which a retroperitoneal organ such as the intestine and it’s overlying peritoneal surface form a side of the hernia sac.
• Hernia sac: A protrusion of the peritoneum through the abdominal wall.
• Direct: A hernia that protrudes directly through the wall of the inguinal canal.
• Indirect: A hernia that enters the inguinal canal through the top rather than through the wall. This is usually caused by the failure of the inguinal canal to close all the way during fetal development.

CPT Coding for Open Inguinal Hernia Repair

The objective of hernia repair is to move the contents of the hernia back into the abdominal cavity and to surgically close the defect. Coders may see this procedure documented as a herniorrhaphy.

CPT has 11 codes to report open repair of inguinal hernias. Repair codes are differentiated based on some of the key terms discussed above. Coders should review the documentation for these key terms to guide them in code selection.

Inguinal repair codes are first divided by whether the hernia is initial or recurrent. Codes for repair of initial inguinal hernia are further divided into four groups based on the age of the patient. Age of the patient is not a deciding factor when selecting a code for repair of recurrent inguinal hernia. Finally, all codes for initial and recurrent inguinal hernias are divided by whether the hernia is reducible or incarcerated/strangulated. There is also a single code for repair of a sliding inguinal hernia. This code is not influenced by whether the hernia is initial or recurrent, reducible or incarcerated/strangulated or the age of the patient. Coders may also see inguinal hernias described as direct or indirect but this is not a factor in selecting repair codes in CPT.

Simultaneous Femoral Hernia Repair

Femoral hernias are another type of groin hernia. They are less common than inguinal hernias and account for approximately 6% of all groin hernias. In some instances, a patient may have a femoral hernia repaired at the same time as an inguinal hernia.

NCCI edits consider repair of a reducible, initial femoral hernia (CPT code 49550) to be integral to repair of a reducible, initial inguinal hernia repair in patients age 5 years or older (CPT code 49505) when performed on the same side through the same incision. For cases that meet this criteria, repair of the femoral hernia is not coded separately. If these types of repairs are performed on opposite sides of the body, anatomic site modifiers can be used to override the edit. However, there are no edits between codes reporting other types of inguinal and femoral hernias being repaired during the same operative episode.

Concomitant Excision of Spermatic Cord Lipoma

In some cases, is may be discovered during an inguinal hernia repair that a patient has a lipoma of the spermatic cord. Excision of a spermatic cord lipoma is reported with code 55520, which is designated as a “Separate Procedure”. In CPT, procedures with this designation are usually considered integral when performed with a more comprehensive procedure. However, Coding Clinic for HCPCS has specified that if the excision of the lipoma is separate and distinct from the excision of the hernia sac it can be reported separately. A -59 or XS modifier are appended to indicate the distinct and separate nature of the lipoma excision.

Take Aways

• Inguinal hernias result from the protrusion of abdominal contents into the inguinal canal through an area of weakness in the abdominal wall.
• Surgical repair of a hernia is called a herniorrhaphy.
• Inguinal hernias are classified by several variables. Coders should review the documentation for key terms related to these variables when selecting repair codes.
• Open repair of an initial, reducible femoral hernia performed through the same incision used to repair an initial, reducible inguinal hernia in patients age 5 years or older is not separately reportable.
• Excision of lipoma of the spermatic cord performed through the same incision used to repair an inguinal hernia is separately reportable when the work of removing the lipoma is separate and distinct from the work required to excise the hernia sac.
• Separate reporting of excision of lipoma of spermatic cord requires assignment of modifier -59 or -XS to identify the separate and distinct nature of the procedure. 

References

Coding Clinic for HCPCS, Third Quarter 2024: Page 10

Coding Clinic for HCPCS, Fourth Quarter 2023: Page 17

Coding Clinic for HCPCS, Third Quarter 2016: Page 2

CPT Codebook 2024