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March 25, 2023

Coding for Hernia Repair

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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.

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  • 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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Last revised February 13, 2023 - Betsy Nicoletti
Tags: general surgery_procedures

CPT®️️ is a registered trademark of the American Medical Association. Copyright American Medical Association. All rights reserved.

2023 E/M reference sheets

These handy quick reference sheets included at-a-glance MDM requirements for office, hospital, nursing home and home and residence services. And, a bonus sheet with typical time for those code sets. Sign up for Betsy’s monthly newsletter to download these reference sheets and share them with your practitioners.

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2023 E/M guidelines for hospital, nursing facility, home and residence services | Webinar

Effective January 1, 2023, the AMA has revised the definitions and guidelines for hospital and other E/M services, including ED visits, nursing facility services, home services, and domiciliary care codes. Also, coding for prolonged care services gets another overhaul with revised codes and guidelines. Watch this webinar about all these changes.

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Our mission is to provide up-to-date, simplified, citation driven resources that empower our members to gain confidence and authority in their coding role.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

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