Summary & Overview
CPT 49507: Incarcerated or Strangulated Inguinal Hernia Repair
CPT code 49507 represents the surgical repair of an incarcerated or strangulated inguinal hernia for initial repair in patients aged 5 years and older. This code is used for operative management when a hernia is trapped or the blood supply is compromised, situations that often require urgent surgical care. Nationally, accurate use of this code matters for clinical documentation, appropriate site-of-service designation, and billing for emergency general surgery procedures.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and typical settings for the procedure, plus what to expect in payer coverage patterns and claims considerations. The report covers benchmarking of utilization and reimbursement themes, common billing modifiers and coding considerations, and relevant policy or coverage updates that affect authorization and payment for urgent hernia repairs.
This publication is intended to inform coding professionals, surgical practices, hospital billing departments, and policy analysts about the coding, clinical circumstances, and payer landscape associated with CPT code 49507. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 49507 describes a surgical repair of an incarcerated or strangulated inguinal hernia performed as the initial hernia repair in patients 5 years of age or older. The procedure addresses hernias that are incarcerated (trapped) or strangulated (compromised blood supply), often requiring urgent or emergent operative intervention.
Service Type: Surgical – Inguinal Hernia Repair, Incarcerated/Strangulated
Typical Site of Service: Hospital operating room or ambulatory surgical center, frequently in settings equipped for urgent or emergency general surgery care.
Clinical & Coding Specifications
Clinical Context
A 62-year-old male presents to the emergency department with sudden-onset severe right groin pain, nausea, and an irreducible bulge. Physical exam demonstrates a tender, nonreducible inguinal mass and signs concerning for ischemia. Imaging and exam lead to a diagnosis of an incarcerated right inguinal hernia with possible strangulation. The surgical team prepares the patient for an urgent open inguinal hernia repair under general anesthesia. Preoperative workflow includes anesthesia evaluation, surgical consent noting the urgency and potential for bowel resection if necrosis is found, operative site marking, and antibiotics per facility protocol. Intraoperative steps include exploration of the hernia sac, reduction attempts, assessment of bowel viability, repair of the defect (often with primary tissue repair or placement of mesh depending on contamination and surgeon judgment), and management of any compromised bowel. Postoperative workflow includes recovery in PACU, pain control, wound monitoring, return of bowel function assessment, and discharge planning with activity and wound care instructions. Typical inpatient stay ranges from same-day discharge for uncomplicated repairs to several days if bowel resection or complications occur. Typical payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/No modifier specified | Used when no specific modifier applies; rare in most claims workflows but present in the provided list |