Summary & Overview
CPT 49555: Recurrent Femoral Hernia Repair
Headline: CPT code 49555 governs surgical repair of recurrent, reducible femoral hernias.
Lead: CPT code 49555 denotes the operative treatment of a recurrent femoral hernia — a defect in the femoral canal allowing abdominal contents to bulge into the upper thigh. This procedure is clinically significant because recurrent femoral hernias carry higher complexity and risk profiles than primary repairs, influencing utilization, perioperative planning, and payer coverage decisions nationwide.
What the code represents and why it matters: CPT code 49555 specifies surgical management of a recurrent, reducible femoral hernia. Nationally, femoral hernias are less common than inguinal hernias but have elevated rates of recurrence and complications when not managed surgically, making accurate coding important for quality measurement, resource allocation, and claims adjudication.
Key payers covered: Analysis and benchmarking typically include major national payers: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: The publication outlines clinical context for femoral hernia recurrence, how CPT code 49555 is used in claims, expected sites of service, and payer applicability. Readers will find benchmarks for utilization and reimbursement patterns, common billing considerations, and any recent policy updates affecting surgical hernia coding and payment. Data limitations: Data not available in the input for payer-specific rates or diagnosis lists.
Billing Code Overview
CPT code 49555 describes the surgical repair of a recurrent femoral hernia in which abdominal contents protrude through the femoral canal into the upper thigh. The procedure addresses a hernia that has previously recurred after prior repair and is described as reducible, meaning the herniated contents can be manually returned to the abdominal cavity.
Service Type: Surgical — Hernia Repair
Typical Site of Service: Hospital operating room or ambulatory surgical center, reflecting the invasive surgical nature of the procedure and requirement for operative facilities and anesthesia when performed.
Clinical & Coding Specifications
Clinical Context
A 62-year-old female with a prior femoral hernia repair presents with a painful, reducible groin bulge below the inguinal ligament. Physical exam and ultrasound confirm a recurrent right femoral hernia containing omentum without bowel obstruction. The patient is prepped for elective surgical repair under general anesthesia. The typical workflow includes preoperative evaluation (history, focused exam, and imaging as needed), informed consent discussing recurrence and repair options, intraoperative exploration of the femoral canal, reduction of herniated contents, and definitive repair using suture or mesh (open approach is common for recurrent femoral hernia). Postoperative care includes immediate recovery in PACU, pain control, wound care instructions, activity restrictions, and a follow-up visit within 1–2 weeks to assess wound healing and recurrence risk. Typical site of service is an ambulatory surgery center or hospital operating room.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typical for 49555 (document justification). |
23 |