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2025 CPT code 49553

Surgical repair of an initial femoral hernia; incarcerated or strangulated.

Follow CPT guidelines and current coding conventions.Consult your payer’s specific guidelines for billing requirements. Ensure that the appropriate modifiers are used as per the guidelines.

Modifiers such as 50 (bilateral procedure), 78 (unplanned return to OR), or others may be applied depending on the circumstances.Appropriate modifier selection is crucial for accurate reimbursement.Consult the CPT manual for guidelines on modifier usage.

Medical necessity for femoral hernia repair is established when the hernia is symptomatic, causing pain, discomfort, or bowel obstruction.Strangulated hernias are always considered medically necessary for immediate repair due to the risk of tissue ischemia and necrosis. Payer policies may vary; consult specific guidelines.

The surgeon's responsibility includes preoperative assessment, surgical planning and execution, and postoperative care. This encompasses proper patient preparation and anesthesia, meticulous surgical technique, repair of the hernia defect, hemostasis, and wound closure.The surgeon might also be responsible for ordering additional imaging or consulting with specialists as needed.

IMPORTANT:49557 (recurrent femoral hernia, incarcerated or strangulated); Additional codes may be necessary depending on the complexity of the case and any additional procedures performed (e.g., intestinal resection).

In simple words: This code describes a surgical operation to fix a femoral hernia. A femoral hernia is a bulge in the upper thigh near the groin. In this specific case, the hernia is either trapped or has its blood supply cut off, requiring immediate surgery. The surgeon will make a cut, repair the hernia, and might use a mesh to prevent it from happening again. If the intestines are damaged, a separate procedure is needed.

This CPT code 49553 encompasses the surgical repair of an initial femoral hernia that is either incarcerated (trapped) or strangulated (blood supply compromised).The procedure involves an incision in the groin area, dissection of the femoral hernia sac, removal of adhesions, assessment of the hernia contents, reduction of the sac (if viable), and potential mesh placement to prevent recurrence.If intestinal resection is necessary, it is reported separately. The surgeon's clinical responsibility includes meticulous tissue handling, hemostasis, and appropriate wound closure.

Example 1: A 65-year-old female presents with a painful, irreducible lump in her right groin. Examination reveals a strangulated femoral hernia. The surgeon performs an open repair with mesh placement. , A 70-year-old male is admitted to the emergency room with severe abdominal pain and nausea. He has an incarcerated femoral hernia. During the open repair, a portion of the bowel is found to be ischemic and requires resection. The surgeon reports both the hernia repair and the bowel resection with appropriate codes., A 40-year-old female presents with a painful reducible femoral hernia. The surgeon performs a laparoscopic repair with mesh placement. The patient makes an uneventful recovery.

* Comprehensive history and physical examination documenting the hernia, its location, and clinical presentation (incarcerated or strangulated).* Preoperative imaging (ultrasound or CT scan) confirming the diagnosis.* Operative report detailing the surgical procedure, including the type of repair, mesh usage, and any complications.* Pathology report if any tissue was removed.* Postoperative progress notes reflecting the patient's recovery and any complications.

** The information provided is based on available data and may not encompass all scenarios.Always consult the most recent CPT manual, NCCI edits, and payer-specific guidelines for accurate coding and billing practices.

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

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