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Official Description

Repair recurrent inguinal hernia, any age; reducible

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

A recurrent inguinal hernia repair is a surgical procedure performed on patients of any age to correct a hernia that has reoccurred after a previous repair. An inguinal hernia occurs when abdominal contents, such as intestines or fatty tissue, protrude through a weak spot in the abdominal wall, specifically in the groin area. The term "reducible" refers to a hernia where the protruding tissue can be pushed back into its normal position within the abdominal cavity. This procedure, identified by CPT® Code 49520, specifically addresses the repair of such reducible hernias. In contrast, CPT® Code 49521 is used for the repair of incarcerated or strangulated hernias, which are more severe conditions where the hernia contents cannot be returned to their original position, and may involve compromised blood flow. The complexity of repairing a recurrent hernia can vary significantly based on factors such as the size of the defect and the degree of scarring or tissue damage from the initial surgical intervention. The surgical approach involves careful dissection and preservation of healthy tissue to ensure optimal outcomes and minimize complications.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure for repairing a recurrent inguinal hernia is indicated in the following situations:

  • Recurrent Inguinal Hernia The patient has a history of a previous inguinal hernia repair that has failed, leading to the reappearance of the hernia.
  • Reducible Hernia The hernia is classified as reducible, meaning that the contents of the hernia sac can be pushed back into the abdominal cavity without difficulty.

2. Procedure

The surgical procedure for repairing a recurrent inguinal hernia involves several critical steps:

  • Step 1: Incision An incision is made over the internal ring of the groin area to access the hernia site. This incision allows the surgeon to visualize and work on the affected area.
  • Step 2: Dissection of Previous Repair The surgeon carefully dissects the previous repair, taking care to preserve healthy tissue surrounding the hernia. This meticulous dissection is crucial to avoid further complications and to ensure the integrity of the surrounding structures.
  • Step 3: Layer Incision The skin, fat, and subcutaneous fascia are incised down to the aponeurosis of the external oblique muscle, exposing the underlying anatomical layers necessary for the repair.
  • Step 4: Identification of External Ring The external ring is identified, and the external oblique aponeurosis is slit to facilitate access to the internal structures of the inguinal canal.
  • Step 5: Opening the Internal Ring The internal ring is opened, allowing the surgeon to expose the inguinal canal fully. This step is essential for accessing the hernia sac.
  • Step 6: Mobilization of Spermatic Cord (in males) In male patients, the spermatic cord and its covering are mobilized, and the covering is removed to provide a clear view of the hernia sac.
  • Step 7: Dissection of Hernia Sac The hernia sac is dissected free into the retroperitoneum, opened, and inspected for any bowel or bladder contents. This inspection is critical to ensure that no vital structures are compromised.
  • Step 8: Reduction of Contents If bowel or bladder contents are present within the hernia sac, they are carefully reduced (pushed back) into the abdominal cavity to restore normal anatomy.
  • Step 9: Transection of Sac The hernia sac is then transected and inverted into the abdominal cavity, which helps to prevent future herniation.
  • Step 10: Placement of Mesh Plug A mesh plug may be placed to reinforce the repair, providing additional support to the weakened area and reducing the risk of recurrence.
  • Step 11: Inspection of Ovary (in females) In female patients, the sac is inspected for the presence of the ovary. If the ovary is found, it is examined and returned to the abdomen if healthy.
  • Step 12: Resection of Sac and Round Ligament The sac is resected along with the round ligament, which is necessary for a complete repair.
  • Step 13: Closure of Internal Ring The internal ring is closed, and the posterior wall of the inguinal canal is repaired to restore the integrity of the abdominal wall.

3. Post-Procedure

After the procedure, patients are typically monitored for any immediate complications. Post-operative care may include pain management, instructions for activity restrictions, and follow-up appointments to assess healing. Patients are advised to avoid heavy lifting and strenuous activities for a specified period to ensure proper recovery and minimize the risk of recurrence. The expected recovery time can vary based on individual factors, but most patients can resume normal activities within a few weeks, depending on their overall health and the complexity of the repair.

Short Descr REREPAIR ING HERNIA REDUCE
Medium Descr RPR RECRT INGUINAL HERNIA ANY AGE REDUCIBLE
Long Descr Repair recurrent inguinal hernia, any age; reducible
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62) 1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P5C - Ambulatory procedures - groin hernia repair
MUE 1
CCS Clinical Classification 85 - Inguinal and femoral hernia repair
RT Right side (used to identify procedures performed on the right side of the body)
LT Left side (used to identify procedures performed on the left side of the body)
GC This service has been performed in part by a resident under the direction of a teaching physician
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
50 Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
53 Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
54 Surgical care only: when 1 physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 to the usual procedure number.
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
62 Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
82 Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).
99 Multiple modifiers: under certain circumstances 2 or more modifiers may be necessary to completely delineate a service. in such situations modifier 99 should be added to the basic procedure, and other applicable modifiers may be listed as part of the description of the service.
AQ Physician providing a service in an unlisted health professional shortage area (hpsa)
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
CR Catastrophe/disaster related
GV Attending physician not employed or paid under arrangement by the patient's hospice provider
GW Service not related to the hospice patient's terminal condition
Q6 Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
SG Ambulatory surgical center (asc) facility service
X4 Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
Date
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2011-01-01 Changed Short description changed.
Pre-1990 Added Code added.
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