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2025 CPT code 49496

Repair of initial inguinal hernia in infants under 6 months, with or without hydrocelectomy; incarcerated or strangulated.

Follow CPT guidelines for hernia repair and the specific instructions provided for this code.Consider payer-specific guidelines.

Modifier 50 (bilateral procedure) may be applicable, unless contraindicated (49591-49622). Other modifiers may be necessary depending on the circumstances of the procedure.

Medical necessity is established by the presence of an inguinal hernia causing symptoms (pain, discomfort, bowel obstruction) or presenting as incarcerated or strangulated (risk of bowel necrosis).

Surgical repair of an inguinal hernia, possibly including hydrocelectomy.Pre-operative assessment, surgical procedure under anesthesia, post-operative care.

IMPORTANT:For preterm infants under 50 weeks postconception age, use codes 49491 or 49492. For infants 6 months to under 5 years old, use codes 49500-49501.Modifier 50 (bilateral procedure) may apply, but not with codes 49591-49622.Codes for excision/repair of strangulated organs (e.g., intestine) are reported separately.

In simple words: This code covers surgery to fix a groin hernia in babies younger than six months old.The surgery repairs the hernia and may also remove fluid from a swelling in the scrotum if present. This type of hernia is urgent because it's either trapped or has a blocked blood supply.

This CPT code describes the surgical repair of an initial inguinal hernia in a full-term infant younger than 6 months of age or a preterm infant older than 50 weeks postconception age and younger than 6 months at the time of surgery.The procedure may also include hydrocelectomy (excision of a hydrocele). The hernia is classified as incarcerated or strangulated. The procedure involves an incision in the groin area, reduction of the herniated tissue, repair of the hernia defect, and reconstruction of the inguinal canal. If present, a hydrocele is incised and fluid is removed. The incision is then closed.

Example 1: A full-term infant presents with a painful, incarcerated inguinal hernia.The surgeon performs an open repair, including hydrocelectomy., A preterm infant (52 weeks postconception) is admitted with a strangulated inguinal hernia.The surgeon performs an emergency repair., A 5-month-old presents with a reducible inguinal hernia.The surgeon performs a planned repair.

Pre-operative assessment, operative report detailing the surgical technique and findings (including whether the hernia was incarcerated or strangulated and if hydrocelectomy was performed), post-operative notes, pathology reports (if applicable).

** Postconception age is calculated as gestational age at birth plus age in weeks at the time of surgery.Accurate documentation is crucial for appropriate coding and reimbursement.

** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.

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