CPT^® revised the codes and concepts used for coding for hernia repair. These are significant changes for surgical procedures that are used very frequently. At the start of the repair codes, the AMA has new language that says “The hernia repair codes in this section are categorized primarily by the type of hernia (inguinal, femoral, lumbar, omphalocele, anterior abdominal, parastomal.)  These are further categorized as initial or recurrent based on whether or not the hernia has required a previous repair. Some codes are further defined by patient age, and some by whether or not the hernia is reducible versus incarcerated or strangulated.

• The new codes are used for any type of repair (open, laparoscopic or robotic) and have 0 global days
• The existing codes are used for open procedures unless the description specifically defines it as laparoscopic, and these continue to have the existing global days
• Having some hernia codes with 0 global days and some with 90 will be a challenge for practices

New codes: repair of anterior abdominal hernias: initial and recurrent

For repair of an initial incisional or ventral hernia that would have been reported with codes 49560 or 49561 now use codes 49591, 49592, 49593, 49594, 49595, and 49596. For repair of recurrent incisional or ventral hernia which would have been reported with codes 49565 or 49566, now use 49613, 49614, 49615, 49616, 49617, 49618.

• These codes are divided into initial and recurrent repairs
• They include implantation of mesh or other prosthesis, when performed
• They are defined both by size and whether the hernia is reducible or incarcerated/ strangulated
• The length of the defect must be documented and is used in code selection
• For more than one hernia, if they are in the same area or adjacent add together the length of the outer perimeters of all defects
• For hernia defects that are separated by greater than 10 cm of intact facia, sum the lengths of each defect
• CMS has assigned zero global days to all of these codes

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