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Official Description

Repair inguinal hernia, sliding, any age

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

A sliding inguinal hernia repair is a surgical procedure performed to correct a specific type of hernia that occurs in the groin area. This condition is characterized by the protrusion of abdominal structures through a weakness in the abdominal wall, specifically in the inguinal region. What distinguishes a sliding inguinal hernia from other types is the presence of a hernia sac that is partially formed by the abdominal viscera, such as bowel or bladder. This can complicate the repair process, as the surgeon must carefully manage the contents of the hernia sac during the procedure. The surgery can be performed on patients of any age, making it a versatile option for addressing this common condition. The procedure involves making an incision over the internal ring of the inguinal canal, through which the surgeon accesses the hernia sac and the surrounding structures. The goal of the repair is to return the herniated contents to the abdominal cavity, close the defect in the abdominal wall, and reinforce the area to prevent recurrence.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The sliding inguinal hernia repair is indicated for patients presenting with a sliding inguinal hernia, which is characterized by the following conditions:

  • Presence of a Sliding Inguinal Hernia The condition involves the protrusion of abdominal contents through a defect in the abdominal wall in the groin area, with the hernia sac partially formed by the abdominal viscera.
  • Symptoms of Hernia Patients may experience symptoms such as a noticeable bulge in the groin, discomfort, or pain, particularly when lifting or straining.
  • Complications The procedure may be indicated if there are complications associated with the hernia, such as incarceration or strangulation of the herniated contents.

2. Procedure

The surgical procedure for repairing a sliding inguinal hernia involves several critical steps, each designed to ensure a successful repair while minimizing risks to the patient.

  • Step 1: Incision An incision is made over the internal ring of the inguinal canal, allowing access to the underlying structures. The incision is carefully planned to provide adequate exposure while minimizing tissue trauma.
  • Step 2: Dissection The skin, fat, and subcutaneous fascia are incised down to the aponeurosis of the external oblique muscle. This dissection is performed meticulously to avoid damaging surrounding tissues.
  • Step 3: Identification of the 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 4: Opening the Internal Ring The internal ring is opened, exposing the inguinal canal. This step is crucial for visualizing the hernia sac and its contents.
  • Step 5: Mobilization of the Spermatic Cord (in males) In male patients, the spermatic cord and its covering are mobilized, and the covering is removed to allow for a clear view of the hernia sac.
  • Step 6: Identification and Opening of the Hernia Sac The hernia sac is identified and opened, revealing the visceral peritoneum that is continuous with a portion of the sac wall. This step is critical for assessing the contents of the sac.
  • Step 7: Reduction of Contents Any bowel or bladder content within the hernia sac is carefully reduced, meaning it is pushed back into the abdominal cavity to restore normal anatomy.
  • Step 8: Transection of the Sac The sac is then transected, with careful attention to protect the viscera and avoid damage to the mesenteric vessels during this process.
  • Step 9: Inversion of the Sac The transected sac is 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 of the abdominal wall.
  • Step 11: Inspection of the Sac (in females) In female patients, the sac is inspected for the presence of the ovary. If the ovary is present and healthy, it is returned to the abdomen.
  • Step 12: Resection of the Sac and Round Ligament The sac is resected together with the round ligament, which is an important step in ensuring a complete repair.
  • Step 13: Closure of the 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 sliding inguinal hernia repair, patients can expect a recovery period that may vary based on individual health factors and the extent of the surgery. Post-procedure care typically includes monitoring for any signs of complications, such as infection or recurrence of the hernia. Patients are often advised to limit physical activity and avoid heavy lifting for a specified period to allow for proper healing. Follow-up appointments may be scheduled to assess the surgical site and ensure that the recovery is progressing as expected. Pain management strategies will also be discussed to help manage any discomfort during the recovery phase.

Short Descr REPAIR ING HERNIA SLIDING
Medium Descr RPR INGUN HERNIA SLIDING ANY AGE
Long Descr Repair inguinal hernia, sliding, any age
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
LT Left side (used to identify procedures performed on the left side of the body)
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
RT Right side (used to identify procedures performed on the right side of the body)
GC This service has been performed in part by a resident under the direction of a teaching physician
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).
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).
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.
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.)
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).
AQ Physician providing a service in an unlisted health professional shortage area (hpsa)
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
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
SG Ambulatory surgical center (asc) facility service
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
Date
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Notes
2011-01-01 Changed Short description changed.
Pre-1990 Added Code added.
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