Inguinal Hernia Repair (Pediatric)

CPT 49505 · 7.76 wRVU · 90-day global
CPT49505
wRVU7.76
Global90-day
ApproachOpen
ComplexityModerate
Add-on / Variant CPTs
  • 49500 wRVU: 5.69 — Inguinal hernia repair, infant under 6 months
  • 49520 wRVU: 9.74 — Recurrent inguinal hernia repair
  • 49521 wRVU: 11.19 — Incarcerated or strangulated inguinal hernia repair
Preoperative Diagnosis:

[Right / left / bilateral] inguinal hernia

Postoperative Diagnosis:

Same

Procedure Performed:

[Right / left / bilateral] inguinal hernia repair with high ligation of patent processus vaginalis

Attending Surgeon:

[Attending name], MD

First Assistant:

[Resident name]

Anesthesia:

[General / combined general + caudal block]

Indications:

Patient is a [X]-year-old [male / female] with [right / left / bilateral] inguinal hernia noted on exam. [No episodes of incarceration.] [Contralateral examination with laparoscope planned.] Risks including recurrence, testicular atrophy / oophorectomy risk, vas deferens injury, and wound infection discussed with parents. Consent obtained.

Findings:

[Right / left] patent processus vaginalis (indirect inguinal hernia). [Bilateral patent processus vaginalis confirmed on contralateral laparoscopic inspection.] No incarcerated contents. [Vas deferens and gonadal vessels identified and protected throughout.]

Description of Procedure:

The patient was positioned supine. [Caudal block placed by anesthesia.] The [right / left] groin was prepped and draped.
A transverse incision was made in the right [/ left] lower abdominal skin crease. Scarpa's fascia was opened. The external oblique fascia was identified and opened along the external inguinal ring. The ilioinguinal nerve was identified and protected. The spermatic cord [/ round ligament] was encircled with a Penrose drain.
The hernia sac (patent processus vaginalis) was identified on the anteromedial aspect of the cord, carefully dissected free from the vas deferens and gonadal vessels, twisted, and ligated at the internal ring with [0-Vicryl / 2-0 silk suture]. The sac was amputated. Hemostasis confirmed. [The internal ring was inspected ([closed adequately / snug closure with one finger breadth admitted]).]
[Contralateral internal ring inspection was performed by passing the laparoscope through the hernia sac into the peritoneal cavity. [No contralateral patent processus vaginalis / contralateral PPV confirmed and repaired bilaterally].]
External oblique fascia closed with [3-0 Vicryl]. Scarpa's fascia approximated. Skin closed with [4-0 Monocryl / Steri-Strips]. Patient tolerated the procedure well.

Complications:

None

Specimens:

[Hernia sac to pathology / None]

Estimated Blood Loss:

Minimal

Drains:

None

Disposition:

Patient to PACU. Discharged home after recovery.

Epic SmartPhrase Version 
PREOPERATIVE DIAGNOSIS: [Right / left / bilateral] inguinal hernia
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: [Right / left / bilateral] inguinal hernia repair with high ligation of patent processus vaginalis
ATTENDING SURGEON: ***, MD/DO
FIRST ASSISTANT: ***
ANESTHESIA: General [+ caudal block]

INDICATIONS: The patient is a .PTAGE-old .PTSEX with [right / left / bilateral] inguinal hernia. No prior incarceration. Risks including recurrence, gonadal injury, and vas deferens injury discussed with parents. Informed consent obtained.

FINDINGS: [Right / left] patent processus vaginalis (indirect inguinal hernia). [Contralateral PPV confirmed / not present on laparoscopic inspection.] Vas deferens and gonadal vessels identified and protected.

DESCRIPTION OF PROCEDURE:
Patient supine. [Caudal block by anesthesia.] Transverse groin crease incision. Scarpa's fascia opened. External oblique fascia opened along external ring. Ilioinguinal nerve identified and protected. Spermatic cord [/ round ligament] encircled with Penrose. Hernia sac (PPV) identified on anteromedial cord, dissected from vas and gonadal vessels, twisted, and ligated at internal ring with 0-Vicryl. Sac amputated. [Contralateral inspection via laparoscope through sac: [no PPV / PPV confirmed and repaired].] External oblique fascia closed with 3-0 Vicryl. Scarpa's fascia approximated. Skin closed with 4-0 Monocryl. Patient tolerated procedure well.

ESTIMATED BLOOD LOSS: Minimal
SPECIMENS: None
COMPLICATIONS: None
DRAINS: None
DISPOSITION: Patient to PACU. Discharged home.

Signed: .ME, .MYDEGREE
.TODAY
Variants

Incarcerated / irreducible inguinal hernia

CPT 49521. Attempt gentle manual reduction before OR. If contents are ischemic, resect non-viable bowel or gonad. Document contents of sac, viability, and management. Higher wRVU (8.05).

Laparoscopic repair (percutaneous internal ring suturing, PIRS)

CPT 49650. Small umbilical port, laparoscopic visualization of internal ring, percutaneous purse-string closure with spinal needle technique. Ideal for bilateral cases. Document bilateral exploration.

Charting Tips
  • Document age, as it determines CPT (under 6 months = 49500, 6 months to 5 years = 49505)
  • State identification and protection of vas deferens and gonadal vessels explicitly
  • Note whether contralateral exploration was performed and findings
  • Document ligation level; at the internal ring (high ligation) is standard
  • For males, note testicular position at end of case (ensure not retracted)
Billing Tips
  • Bill 49505 for open repair of initial inguinal hernia, age 6 months to 5 years (5.20 wRVU, 90-day global). Bill 49500 for infant under 6 months (6.25 wRVU). Bill 49520 for recurrent inguinal hernia. Bill 49650 for laparoscopic initial inguinal hernia repair.
  • Bilateral repair at same session: bill 49505 for one side and 49505-50 (bilateral modifier) or use 49525/49525. Many payers accept bilateral modifier. Document both sides explicitly in the operative note.
  • Sliding hernia or incarcerated hernia: bill 49525 (sliding) or 49521 (incarcerated, requires reduction). Incarcerated hernia commands higher wRVU; document whether hernia was reducible or required operative reduction.
  • Contralateral exploration: laparoscopic internal ring inspection through the ipsilateral hernia site is commonly performed in infants. If contralateral patent processus vaginalis is found and repaired, bill the contralateral repair as well. Document exploration and findings on each side.
  • 90-day global: routine postoperative visit is bundled. Hydrocele or recurrence presenting after global period are separately billable.

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