Medical Codes for Reporting and Coding Inguinal Hernia

1. Medical Codes for Reporting and Coding Inguinal Hernia An inguinal hernia occurs in the abdomen near the groin area. This article discusses inguinal hernia along with the ICD-10, CPT and HCPCS codes. Outsource Strategies International www.outsourcestrategies.com 918-221-7769 United States

2. If you experience a slight pain in your groin, which becomes severe when you cough or lift something heavy, then it must be a symptom of inguinal hernia. An inguinal hernia occurs at the inguinal canal in the groin region. It develops when fatty or intestinal tissues protrude through a weak spot in the abdominal wall muscles, near the right or left inguinal canal. Each inguinal canal resides at the base of the abdomen. Both men and women have inguinal canals. The condition can appear as a swelling or bulge in your groin or as an enlarged scrotum (the pouch containing the testicles). The resulting lump may be painful, which often appears when you are lifting something heavy and disappears when you lie down. In most cases, this type of hernia is not very dangerous and may appear as small and does not cause any specific signs or symptoms. However, enlarging or painful hernias usually require surgery to relieve discomfort and prevent serious complications. General surgeons or other physicians performing this surgical procedure need to correctly document the same in the patient’s medical records. Opting for billing and coding services from a reliable and established medical billing and coding company can help simplify the documentation process and ensure correct reimbursement. Inguinal hernia repair is one of the most frequently performed surgeries in the United States. It is estimated that approximately 800,000 are to repair inguinal hernias and the rest are for other types of hernias (2018 statistics). The condition may arise at any time from infancy to adulthood. However, the condition is far more common in males than females – with a lifetime risk of 27 percent in men and 3 percent in women. In most cases, the abdominal wall weakness – a prominent cause that leads to an inguinal hernia – occurs during birth (when the abdominal lining (peritoneum) doesn't close properly). Other inguinal hernias develop later in life when muscles weaken or deteriorate due to aging, strenuous www.outsourcestrategies.com 918-221-7769

3. physical activity, a pre-existing weak spot in the abdominal wall, difficulty with bowel movements and urination and chronic coughing or sneezing. Weaknesses can also occur in the abdominal wall later in life, especially after an injury or abdominal surgery. Types of Inguinal Hernias Inguinal hernias include four different types such as direct or indirect, incarcerated, or strangulated. Direct inguinal hernia– According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), this type of hernia is much more prevalent in men. The condition, (which most often occurs in adults as they age), is caused by the connective tissue degeneration of the abdominal muscles, which causes weakening of the muscles during the adult years. Indirect inguinal hernia –These are congenital hernias that are much more common in males than females. It often occurs in premature births, before the inguinal canal becomes closed off. Incarcerated inguinal hernia–This type occurs when the tissue gets stuck in the groin or scrotum and cannot be pushed back in to the abdomen. Strangulated inguinal hernia– Regarded as a serious condition that requires immediate medical attention, strangulated inguinal hernia occurs when the blood supply to the incarcerated small intestine is stopped. Common Symptoms Inguinal hernias are most noticeable by their appearance. One of the very first symptoms of the condition involves a small bulge on one or both sides of the groin www.outsourcestrategies.com 918-221-7769

4. (in very rare cases)that can appear to increase in size when you stand up or cough. Other related symptoms include - Discomfort or pain in the groin (especially when straining, lifting, coughing, or exercising that improves when resting) Feelings such as weakness or heaviness in the groin Swelling of the scrotum in men Sudden pain that quickly intensifies Occasional pain and swelling around the testicles when the protruding intestine descends into the scrotum Nausea, vomiting or both Inability to move your bowels or pass gas A burning or aching sensation at the bulge Diagnosis and Treatment Methods Inguinal hernia is generally diagnosed through a detailed physical examination wherein the physician will check or feel for a bulge in the groin area that gets larger when you stand up, cough or strain. Imaging tests like abdominal ultrasound, CT scan or MRI scan will also be done as part of the diagnosis. Treatment options for this condition depend on the size and type of hernia and the severity of your symptoms. If the hernia is small and isn’t really causing any specific symptoms or bothering patients, then physicians may generally recommend watchful waiting. In some cases, wearing a supportivetruss may help relieve symptoms to a great extent. However, it is important to check with the physician whether the truss fits in properly. On the other hand, in children, the physician may try applying manual pressure to reduce the bulge before considering surgery. www.outsourcestrategies.com 918-221-7769

5. For enlarging or painful hernias - surgery is the primary treatment - that helps relieve discomfort and prevent serious complications. There are two types q hernia operations — open hernia repair and laparoscopic repair (keyhole surgery). In open hernia repair, the surgeon makes an incision and pushes the protruding tissue back into the abdomen. The procedure is performed under local anesthesia and sedation or general anesthesia and the surgical opening is closed with stitches, staples or surgical glue. Laparoscopy is a minimally invasive procedure done under general anesthesia. In this technique, several small incisions are made in the abdomen, thereby allowing the surgeon to use various special instruments to repair the hernia. Early surgical procedures can help heal inguinal hernias. However, there is always a slight risk of recurrence and complications and these include infection after surgery or poor surgical wound healing. General surgery medical coding involves using the specific ICD-10 diagnosis codes, CPT procedure codes and HCPCS codes for reporting inguinal hernia on your medical claims. ICD -10 Codes K40 - Inguinal hernia K40.0 - Bilateral inguinal hernia, with obstruction, without gangrene K40.00 - Bilateral inguinal hernia, with obstruction, without gangrene, not specified as recurrent K40.01 - Bilateral inguinal hernia, with obstruction, without gangrene, recurrent K40.1 - Bilateral inguinal hernia, with gangrene K40.10 - Bilateral inguinal hernia, with gangrene, not specified as recurrent www.outsourcestrategies.com 918-221-7769

6. K40.11 - Bilateral inguinal hernia, with gangrene, recurrent K40.2 - Bilateral inguinal hernia, without obstruction or gangrene K40.20 - Bilateral inguinal hernia, without obstruction or gangrene, not specified as recurrent K40.21 -Bilateral inguinal hernia, without obstruction or gangrene, recurrent K40.3 - Unilateral inguinal hernia, with obstruction, without gangrene K40.30 - Unilateral inguinal hernia, with obstruction, without gangrene, not specified as recurrent K40.31 - Unilateral inguinal hernia, with obstruction, without gangrene, recurrent K40.4 - Unilateral inguinal hernia, with gangrene K40.40 - Unilateral inguinal hernia, with gangrene, not specified as recurrent K40.41 -Unilateral inguinal hernia, with gangrene, recurrent K40.9 - Unilateral inguinal hernia, without obstruction or gangrene K40.90 - Unilateral inguinal hernia, without obstruction or gangrene, not specified as recurrent K40.91 - Unilateral inguinal hernia, without obstruction or gangrene, recurrent CPT Codes 49492 - Repair, initial inguinal hernia, preterm infant (younger than 37 weeks gestation at birth), performed from birth up to 50 weeks post conception age, with or without hydrocelectomy; incarcerated or strangulated www.outsourcestrategies.com 918-221-7769

7. 49495 - Repair, initial inguinal hernia, full term infant younger than age 6 months, or preterm infant older than 50 weeks postconception age and younger than age 6 months at the time of surgery, with or without hydrocelectomy; reducible 49496 - Repair, initial inguinal hernia, full term infant younger than age 6 months, or preterm infant older than 50 weeks postconception age and younger than age 6 months at the time of surgery, with or without hydrocelectomy; incarcerated or strangulated 49500 - Repair initial inguinal hernia, age 6 months to younger than 5 years, with or without hydrocelectomy; reducible 49501 - Repair initial inguinal hernia, age 6 months to younger than 5 years, with or without hydrocelectomy; incarcerated or strangulated 49505 - Repair initial inguinal hernia, age 5 years or older; reducible 49507 - Repair initial inguinal hernia, age 5 years or older; incarcerated or strangulated 49520 - Repair recurrent inguinal hernia, any age; reducible 49521 - Repair recurrent inguinal hernia, any age; incarcerated or strangulated 49525 - Repair inguinal hernia, sliding, any age 49650 - Laparoscopy, surgical; repair initial inguinal hernia 49651 - Laparoscopy, surgical; repair recurrent inguinal hernia HCPCS Codes • C1726 - Catheter, balloon dilatation, non-vascular • C1781 - Mesh (implantable) • C9364 - Porcine implant, permacol, per square centimeter www.outsourcestrategies.com 918-221-7769

8. Although you cannot prevent the congenital defects or genetic risk factors that make a person susceptible to inguinal hernia, it is possible to prevent the risk of occurrence. This can be done by integrating positive lifestyle habits like – maintaining a healthy body weight, stopping the habit of smoking, consuming high-fiber foods and avoiding lifting heavy objects. Knowing the highly specific medical codes and payer-specific guidelines related to billing and coding inguinal hernia is crucial. Partnering with a reliable and professional medical billing company can ensure correct and on-time reimbursement. www.outsourcestrategies.com 918-221-7769