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Official Description

Repair initial femoral hernia, any age; reducible

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

An initial femoral hernia repair is a surgical procedure performed to correct a femoral hernia, which occurs when tissues protrude through a weakness in the groin area into the upper thigh. This condition can affect individuals of any age. The CPT® Code 49550 specifically denotes the repair of a reducible femoral hernia, meaning that the contents of the hernia sac can be pushed back into their normal anatomical position. During the procedure, a surgical incision is made in the thigh, just below the inguinal ligament, to access the femoral canal. The surgeon carefully dissects through the subcutaneous fat to expose the extraperitoneal fat surrounding the hernia sac. Through blunt dissection, the mass of peritoneal fat is freed, allowing for the identification of the inguinal ligament, the overlying fascia, and the neck of the hernia. The procedure involves inspecting the contents of the hernia sac, which may include bowel or omentum, and returning them to the abdominal cavity. The hernia sac is then ligated at its neck and transected, with the remaining stump also returned to the abdominal cavity. Finally, the inguinal ligament is sutured to Cooper's ligament, and a mesh plug may be applied to reinforce the repair. It is important to note that if the hernia is found to be strangulated or incarcerated, the appropriate code to use would be 49553, as these conditions involve complications where the hernia contents cannot be reduced or where blood supply is compromised.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure for repairing an initial femoral hernia is indicated for patients presenting with the following conditions:

  • Femoral Hernia A condition characterized by the protrusion of tissues through a weakness in the groin area into the upper thigh, which is reducible.

2. Procedure

The surgical procedure for the repair of a reducible femoral hernia involves several critical steps:

  • Step 1: Incision An incision is made in the thigh, located just below the inguinal ligament, to access the femoral canal where the hernia is situated.
  • Step 2: Dissection The surgeon carefully splits the subcutaneous fat to expose the extraperitoneal fat that envelops the hernia sac. This step is crucial for gaining access to the hernia.
  • Step 3: Freeing the Fat Mass Using blunt dissection techniques, the mass of peritoneal fat is freed, allowing the surgeon to visualize the inguinal ligament, the overlying fascia, and the neck of the hernia.
  • Step 4: Exposing the Hernia Sac The fat mass is split, and the hernia sac is exposed. The dissection continues up to and beyond the neck of the hernia, allowing for a thorough inspection of the sac's contents.
  • Step 5: Inspection of Contents The contents of the hernia sac, which may include bowel or omentum, are inspected to ensure there are no complications such as strangulation.
  • Step 6: Returning Contents After inspection, the bowel and omentum are gently returned to the abdominal cavity to restore normal anatomy.
  • Step 7: Ligating the Sac The hernia sac is ligated at its neck and then transected. The remaining stump of the sac is also returned to the abdominal cavity.
  • Step 8: Suturing The inguinal ligament is sutured to Cooper's ligament to secure the repair and reinforce the area.
  • Step 9: Mesh Application A mesh plug may be applied to provide additional support and reduce the risk of recurrence of the hernia.

3. Post-Procedure

Post-procedure care for patients who have undergone an initial femoral hernia repair typically includes monitoring for any signs of complications, such as infection or recurrence of the hernia. Patients are advised to follow specific recovery guidelines, which may include restrictions on physical activity and lifting for a designated period to ensure proper healing. Follow-up appointments are essential to assess the surgical site and overall recovery progress.

Short Descr RPR REM HERNIA INIT REDUCE
Medium Descr RPR 1ST FEM HRNA ANY AGE REDUCIBLE
Long Descr Repair initial femoral 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)
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).
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.)
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).
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
GC This service has been performed in part by a resident under the direction of a teaching physician
LT Left side (used to identify procedures performed on the left side of the body)
SG Ambulatory surgical center (asc) facility service
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
Action
Notes
2011-01-01 Changed Short description changed.
Pre-1990 Added Code added.
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