Repair umbilical hernia, age 5 years or older; reducible
Relative Value Units (RVUs)
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Clinical Information
When to Use
For repair of reducible umbilical hernia in patients age 5 years or older
Common Scenarios
Documentation Requirements
- Hernia size and reducibility
- Surgical approach (primary vs mesh repair)
- Fascial defect size
- Closure technique
- Any complications
Coding Guidelines
Common Modifiers
Bundling Rules
- Includes hernia sac dissection and reduction
- Includes fascial repair
- Mesh placement bundled when performed same session
- Local anesthesia bundled when performed same session
- Wound closure bundled when performed same session
Exclusions
- 49587 (incarcerated umbilical hernia)
- 49652 (laparoscopic umbilical hernia repair)
- 49540 (epigastric hernia repair)
Coding Notes
Clinical scenarios
- Hernia size and reducibility
- Surgical approach (primary vs mesh repair)
- Fascial defect size
- Hernia size and reducibility
- Surgical approach (primary vs mesh repair)
- Fascial defect size
- Hernia size and reducibility
- Surgical approach (primary vs mesh repair)
- Fascial defect size
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Code Details
Medicare Pricing
Pricing data not available for this code.
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Ask a QuestionFrequently Asked Questions
CPT 49585 is the billing code for "Repair umbilical hernia, age 5 years or older; reducible". For repair of reducible umbilical hernia in patients age 5 years or older
CPT 49585 has a total RVU of 14.35, broken down as: Work RVU 6.50, Practice Expense RVU 7.20, and Malpractice RVU 0.65. RVUs (Relative Value Units) determine Medicare reimbursement rates.
Key documentation requirements for CPT 49585 include: Hernia size and reducibility; Surgical approach (primary vs mesh repair); Fascial defect size; Closure technique. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 49585: Includes hernia sac dissection and reduction. Includes fascial repair Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 49585 include: 51 (Multiple procedures performed same session), 22 (Increased procedural services for complex repair), 52 (Reduced services if procedure not completed). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 49585 is 30-50 minutes typical operative time. Time-based codes require documentation of the actual time spent providing the service.