Blue Cross of Idaho Logo

Express Sign-on

Thank you for registering with Blue Cross of Idaho

If you are an Individual or Family Member under age 65, please register here.

If you are an Medicare or Medicare Supplement member, please register here.

New Options for Affordable Health Insurance

MP 6.01.11 Herniography

Medical Policy
Section
Radiology
Original Policy Date
3/31/96
Last Review Status/Date
Reviewed by consensus/3:2003
Issue
3:2003
Return to Medical Policy Index

Disclaimer

Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract.  Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage.  Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.


Description

Herniography is an imaging test performed to evaluate the presence of a suspected hernia. A contrast agent is injected into the abdominal or peritoneal cavity, followed by radiography of the pelvic floor and its peritoneal reflections.


Policy

Herniography is considered not medically necessary.


Policy Guidelines

There is no specific CPT code for herniography. CPT code 74190 (peritoneogram) would be most commonly used. Similar to herniography, it is anticipated that peritoneograms would be a low volume test, due to the preference for other noninvasive abdominal imaging tests.


Benefit Application

No applicable information


Rationale

Herniography may be performed to evaluate the presence of a groin hernia when the clinical diagnosis is uncertain. However, patients presenting with unexplained groin or abdominal pain typically undergo initial, more general, abdominal imaging, with either a CT scan or abdominal ultrasound. In this setting, herniography as a follow-up test would be rarely warranted. Individual providers may prefer herniography as an initial diagnostic test in lieu of other abdominal imaging tests. However, it is anticipated that herniography would be a very low volume test.

References:

  1. Harrison LA, Keesling CA, Martin NL. Abdominal wall hernias: review of herniography and correlation with cross-sectional imaging. Radiographics 1995; 15(2):315-22.
  2. Hamlin JA, Kahn AM. Herniography: a review of 333 herniograms. Am Surg 1998; 64(10):965-9.

Source:

A search of literature was completed through the MEDLINE database for the period of January 1995 through December 1998. The search strategy focused on references containing the following words:

– Hernia
 
– Radiography
 
– Herniography

 

Codes

Number

Description

CPT  49400  Injection of air or contrast to peritoneal cavity 
  74190  Peritoneogram (e.g., after injection of air or contrast) radiologic supervision and interpretation 
ICD-9 Procedure  88.11  Pelvic opaque dye contrast radiography 
ICD-9 Diagnosis  550–553  Hernia of abdominal cavity 
HCPCS   
Type of Service  Radiology 
Place of Service  Outpatient 


Index

Herniography
Imaging, hernia


Policy History

Date Action Reason
03/31/96 Add to Radiology section New policy
01/27/99 Replace policy Policy reviewed and unchanged; added additional references
04/15/02 Replace policy Policy reviewed without literature review; new review date only
10/09/03 Replace policy Policy reviewed by consensus without literature review; no changes in policy; no further review scheduled


Search for Policies

Policy Feedback