Table of Contents

Basics of Hernia Repair CPT codes

Hernia repair procedures are performed in outpatient setting. Hernia can be congenital or acquired and are caused often by strain or injury. There are certain key elements to remember while coding hernia repair cpt codes or procedures.

Type of hernia
Age of the patient
Initial or recurrent hernia
Surgical approach (open or laparoscopic)

Also, the mesh used for certain hernia repair, should be coded carefully, since it is included in some of the hernia repair procedures. there are different procedure code used for coding hernia repair.

Significant coding changes take effect in 2023 for reporting anterior abdominal hernia repair, including:

Deletion of codes 49560–49590, which describe open repair of anterior abdominal hernias
Deletion of codes 49652–49657, which describe laparoscopic repair of anterior abdominal hernias
Deletion of add-on code 49568, which was reported for implantation of mesh for open ventral/incisional hernias and defects resulting from necrotizing soft tissue infection
Twelve new codes (49591–49596 and 49613-49618) to report anterior abdominal hernia repair by any approach (i.e., open, laparoscopic, robotic), further by initial or recurrent hernia, further by total defect size, and further by reducible or incarcerated/strangulated
Two new codes (49621–49622) to report parastomal hernia repair by any approach (i.e., open, laparoscopic, robotic), further divided by reducible or incarcerated/strangulated
One new add-on code (49623) for removal of mesh/prosthesis at the time of initial or recurrent anterior abdominal hernia repair or parastomal hernia repair

CPT codes used for hernia repair

There are different codes used for a reducible hernia in which the contents of the hernia sac can be pushed back into normal position, is repaired. Similarly there are cpt codes for repair of an incarcerated or strangulated hernia.

49491– Repair, initial inguinal hernia, preterm infant (younger than 37 weeks gestation at birth), performed from birth up to 50 weeks postconception age, with or without hydrocelectomy; reducible

49492– Repair, initial inguinal hernia, preterm infant (younger than 37 weeks gestation at birth), performed from birth up to 50 weeks postconception age, with or without hydrocelectomy; incarcerated or strangulated

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

49550 Repair initial femoral hernia, any age; reducible

49553 incarcerated or strangulated

49555 Repair recurrent femoral hernia; reducible

49557 incarcerated or strangulated

(49560, 49561 have been deleted. For repair of initial incisional or ventral hernia, see 49591, 49592, 49593, 49594, 49595, 49596)

(49565, 49566 have been deleted. For repair of recurrent incisional or ventral hernia, see 49613, 49614, 49615, 49616, 49617, 49618)

49591 Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); less than 3 cm, reducible

49592 less than 3 cm, incarcerated or strangulated

49593 3 cm to 10 cm, reducible

49594 3 cm to 10 cm, incarcerated or strangulated

49595 greater than 10 cm, reducible

49596 greater than 10 cm, incarcerated or strangulated

49613 Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), recurrent, including implantation of mesh or other prosthesis when performed, total length of defect(s); less than 3 cm, reducible

49614 less than 3 cm, incarcerated or strangulated

49615 3 cm to 10 cm, reducible

49616 3 cm to 10 cm, incarcerated or strangulated

49617 greater than 10 cm, reducible

49618 greater than 10 cm, incarcerated or strangulated

49621 Repair of parastomal hernia, any approach (ie, open, laparoscopic, robotic), initial or recurrent, including implantation of mesh or other prosthesis, when performed; reducible

49622 incarcerated or strangulated

49623 Removal of total or near total non-infected mesh or other prosthesis at the time of initial or recurrent anterior abdominal hernia repair or parastomal hernia repair, any approach (ie, open, laparoscopic, robotic) (List separately in addition to code for primary procedure)

(Use 49623 in conjunction with 49591-49622)

(For removal of infected mesh, use 11008)

49525– Repair inguinal hernia, sliding, any age

49540 – Repair lumbar hernia

CPT code 49568 is deleted. Implantation is incorporated in 49591-49622, do not report separately. CPT code 49560, 49561 are deleted. Report initial repair codes: 49591, 49592, 49593, 49594, 49595, 49596.

CPT code 49565, 49566 deleted. Report recurrent repair codes: 49613, 49614, 49615, 49616, 49617, 49618.

Different types of hernia

The most common site for occurrence for hernia is groin (inguinal) where a loop of intestine bulges through an opening of muscle in the inguinal canal.

Femoral hernia occurs just below the groin in the middle of the thigh. A femoral hernia will appear as a bulge near the groin or thigh

An umbilical hernia creates a soft swelling or bulge near the navel. It occurs when part of the intestine protrudes through the umbilical opening in the abdominal muscles.

A hernia at the site of a previous surgical incision is referred to as an incisional or ventral hernia.

Epigastric hernias are located in the mid-upper abdomen and a Spigelian hernia is a ventral hernia that occurs through the spigelian fascia.

Hernia are also differentiated as reducible versus incarcerated or strangulated and as initial or recurrent. A reducible hernia can be repaired non-surgically by manipulation while in incarcerated hernia the intestine gets trapped and is no longer can be treated through manipulation and hence surgery is the only option for repair.

Incarcerated hernias are those in which the contents of the hernia sac cannot be pushed back to their normal position. Strangulated hernias are those in which circulation is compromised.

Point to remember for coding hernia repair cpt codes

There are different codes for hernia repair, Hernioplasty, Herniorrhaphy, Herniotomy. Always check the key elements while coding the correct cpt codes. The surgical approach (open or laparoscopic) should be check before assign the appropriate hernia repair CPT code.

Mesh is often utilized in repair of the hernia to create a tension free repair which minimizes the risk for recurrence. The utilization of mesh is considered inherent to the surgical procedure with the exception of incisional or ventral hernias.

5 thoughts on “Hernia Repair CPT codes : Best coding guide”

sriananya
June 25, 2020 at 12:57 pm
A hernia means something coming through. It most frequently occurs when an organ or internal tissue pokes through a hole or weakness in your abdominal muscle wall.
So i would like to recommend you the best hernia hospitals in Hyderabad which is ananya hospitals . It does the best laparoscopic hernia surgery in Hyderabad. Not only hernia it is also known for its medical and surgical gastroenterology.
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