Summary & Overview
CPT 49557: Recurrent Femoral Hernia Repair, Incarcerated or Strangulated
CPT code 49557 denotes surgical repair of a recurrent femoral hernia that is incarcerated or strangulated. This code captures an acute surgical intervention to relieve trapped abdominal contents and restore perfusion when blood supply is compromised. Nationally, procedures of this type are clinically urgent and have implications for hospital resource use, operative coding accuracy, and postoperative care pathways.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for the code, typical sites of service, and the service type. The publication also summarizes common modifiers used with this service, typical payer considerations, and related coding references where available. Benchmarks cover utilization patterns and allowed payment considerations (when available), and the publication highlights policy and coverage factors that commonly affect adjudication of acute hernia repairs.
This resource is intended to inform coding professionals, surgical departments, and billing teams about the clinical scenario represented by CPT code 49557, and what to expect in terms of coding classification and payer engagement for urgent femoral hernia repairs.
Billing Code Overview
CPT code 49557 describes the surgical repair of a recurrent femoral hernia that is incarcerated or strangulated. In this procedure, abdominal contents—most commonly intestine—protruding through the femoral canal are addressed surgically to relieve entrapment or restore compromised blood flow.
Service type: Surgical—emergency/urgent hernia repair
Typical site of service: Inpatient operating room or emergency surgical suite, reflecting the acute nature of incarcerated or strangulated hernias.
Clinical & Coding Specifications
Clinical Context
A 62-year-old female presents to the emergency department with acute right groin pain, a palpable tender mass below the inguinal ligament, nausea, and obstipation. Imaging and exam confirm a recurrent incarcerated femoral hernia with concern for bowel compromise. The patient has a prior open femoral hernia repair on the same side. After preoperative assessment, informed consent, and anesthesia evaluation, the patient is brought to the operating room for surgical repair. The provider performs open surgical repair of the recurrent incarcerated/strangulated femoral hernia, reduces viable bowel or performs bowel resection if nonviable, and reconstructs the femoral canal (with or without mesh depending on contamination and surgeon judgment). The typical workflow includes preoperative antibiotics, general or regional anesthesia, intraoperative assessment of bowel viability, possible bowel resection with anastomosis if strangulated, closure with appropriate drains if used, and postoperative monitoring in the PACU with admission for observation or further care as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | (Not a standard CMS modifier for claims) | Data not available in the input. |
11 |