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General Surgery Coding Alert

Reader Question:
49553, 49557: Reserve for Open Procedures

Question: If the surgical note doesn't indicate whether an incarcerated femoral hernia is initial or recurrent, how do we choose between 49553 or 49557 for a laparoscopic pre-peritoneal repair? Ohio SubscriberAnswer: Neither code that you suggest is appropriate for the procedure you describe. That's because your surgeon performed a laparoscopic procedure, while both codes that you suggest describe an open procedure, as follows:49553 -- Repair initial femoral hernia, any age; incarcerated or strangulated49557 -- Repair recurrent femoral hernia; incarcerated or strangulated.Instead, you should list the procedure using unlisted code 49659 (Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy). CPT® doesn't provide a specific code for laparoscopic femoral hernia repair.