An abdominal hernia is a protrusion of part of the intestines through a weakened section of the abdominal cavity; herniations can occur in other parts of the body, such as muscle herniations. This article addresses abdominal hernias.
Surgery is directed at permanently closing off the orifice through which the abdominal structures protrude. Sometimes, the hernia can be manually reduced, but this is not a permanent intervention. There isn’t a code for medical reduction of a hernia, it is part of an E/M service.
Codes in the abdominal repair section of CPT® (49491—49659) are categorized primarily by the type of hernia being repaired, location and the approach (open vs laparoscopic).
Some are further defined as initial or recurrent, depending on whether or not the hernia has required prior surgical repair. Some hernia repair codes are based on the age of the patient, and some are based on the clinical presentation, reducible versus incarcerated or strangulated.
The last update in hernia coding was in 2009. So, if you are an experienced general surgery coder, you can skip this article. If you are new to general surgery coding, read on.
- Placement of mesh (49568) is an add-on code for incisional or ventral hernia repairs, performed via an open approach. The range of codes that CPT®code 49568 may be reported with is 11004-11006, 49560—49566. The facility may bill for mesh in other cases, but there is not a separate physician charge.
Remember, you may only report code +49568 only with an open incisional or ventral hernia
- Append modifier 50, when appropriate for bilateral hernia repairs, via the same approach for the same type of condition (e.g. bilateral recurrent inguinal hernias, bilateral initial hernias). Do not append a modifier 50 to a right initial inguinal hernia and a recurrent left inguinal hernia, both repaired via the same approach.
- If either an incisional or ventral hernia repair is done at the time of another abdominal procedure, through the same incision, do not separately report the hernia repair. It is considered inclusive of the other procedure.
- The open hernia repair codes are found in the range of codes 49491-49611
- The laparoscopic codes are found in the CPT®range of codes, 49650-49657
- CPT®code 49659, unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy is reported when a CPT® code does not exist for the type of repair performed.
Definitions from webmd.com
An incisional hernia, occurs when the intestine pushes through the abdominal wall at the site of previous abdominal surgery. This type is most common in elderly or overweight people who are inactive after abdominal surgery.
A femoral hernia occurs when the intestine enters the canal carrying the femoral artery into the upper thigh. Femoral hernias are most common in women, especially those who are pregnant or obese.
An umbilical hernia, occurs when part of the intestine passes through the abdominal wall near the navel. Common in newborns, it also commonly afflicts obese women or those who have had many children.
A hiatal hernia happens when the upper stomach squeezes through the hiatus, an opening in the diaphragm through which the esophagus passes.
A reducible hernia is one that can be pushed back into the abdomen by manual pressure or gravity or surgical reduction. The contents are mobile within the hernia.
An incarcerated or strangulated hernia cannot be reduced manually; these are non-reducible hernias. An incarcerated hernia has the contents of the hernia trapped in the weak part of the abdominal wall. A strangulated hernia is a hernia that cuts of the blood supply to the intestines and other tissues of the abdomen; strangulated hernias are medical emergencies. Strangulation, when pressure compresses the blood vessels and begins to cut off the blood supply to the contents of the hernia, is a serious and potentially life-threatening complication.
CPT® codes
The charts below show CPT® codes and descriptions.
Frequently billed hernia procedures:
49505 Repair initial inguinal hernia, age 5 years or older; reducible
49560 Repair initial incisional or ventral hernia; reducible
+49568 Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair)
- Use 49568 with 11004—11006, 49560–49566
49585 Repair umbilical hernia, age 5 years or older; reducible
49650 Laparoscopy, surgical; repair initial inguinal hernia
If there is no laparoscopic code for the type of hernia being repaired, do not use an open code. Use the unlisted code 49569.
Having trouble selecting the correct code?
Work with your surgeons to ensure they are including the required documentation for code selection:
- The type of hernia (e.g., inguinal, femoral, incisional)
- “Initial” or “recurrent” based on whether or not the hernia has required previous repair(s)
- Patient age
- Reducible vs. incarcerated or strangulated
- Open versus laparoscopic
- With or without mesh (only reported with CPT®code ranges 49560-49566)
Coding for inguinal hernias: open repair
When coding for inguinal hernias, codes are selected based on the age of the patient, and whether the hernia is reducible or is incarcerated or strangulated. Adult inguinal hernia codes are also further defined by whether they are initial or recurrent.
The intestine or the bladder protrudes through the abdominal wall or into the inguinal canal in the groin. About 96% of all groin hernias are inguinal, and most occur in men because of a natural weakness in this area.
When coding for a sliding inguinal hernia, the code is not defined as to whether the hernia is recurrent or incarcerated.
| Code | Description |
| 49505 | Repair initial inguinal hernia, age 5 years or older; reducible |
| 49507 | incarcerated or strangulated |
| 49520 | Repair recurrent inguinal hernia, any age; reducible |
| 49521 | incarcerated or strangulated |
| 49525 | Repair inguinal hernia, sliding, any age |
| Code | Description |
| 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 | 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; |
| 49496 | reducible |
| 49500 | Repair initial inguinal hernia, age 6 months to younger than 5 years, with or without hydrocelectomy; reducible |
| 49501 | incarcerated or strangulated |
- For hernia repair with simple orchiectomy, see 49505 or 49507 and 54520.
- For hernia repair with excision of a hydrocele or spermatocele, see 49505 or 49507 and 54840 or 55040.
- +49568, insertion of mesh, may not be reported with any of these codes.
Laparoscopic hernia repair
| Type of hernia | Code selection definition |
| Inguinal | Initial or recurrent |
| Ventral, umbilical, spigelian or epigastric | Reducible or incarcerated/strangulated |
| Incisional | Reducible or incarcerated/strangulated |
| Recurrent incisional | Reducible or incarcerated/strangulated |
| Code | Description |
| 49650 | Laparoscopy, surgical; repair initial inguinal hernia |
| 49651 | repair recurrent inguinal hernia |
| 49652 | Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); reducible |
| 49653 | incarcerated or strangulated |
| 49654 | Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); reducible |
| 49655 | incarcerated or strangulated |
| 49656 | Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); reducible (includes mesh insertion, when performed); reducible |
| 49657 | incarcerated or strangulated |
| 49659 | Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy |
- Surgical laparoscopy always includes diagnostic laparoscopy. Do not report 49320 with these codes.
- You may not bill 49652, 49653, 49654, 49655, 49656, or 49657 with 44180 (laparoscopic lysis of adhesions) or +49568 (implantation of mesh). All laparoscopic hernia repair codes include mesh implantation. In 2009, the word “open” was added to the definition of code +49568.
- The laparoscopic codes, 49652—49657, all include the words (includes mesh insertion, when performed.)
- For other types of hernia repair performed laparoscopically, use unlisted code 49659.
Ventral and other types of hernia, open repair
Includes repair of umbilical, epigastric, Spigelian and incisional hernias.
Ventral and other hernia repair
| Incisional | Initial or recurrent, reducible or incarcerated/strangulated |
| Umbilical | Under or over age 5, reducible or incarcerated/strangulated |
| Epigastric | Reducible or incarcerated/strangulated |
| Femoral hernia | Initial or recurrent, reducible or incarcerated/strangulated |
Incisional or ventral
| Code | Description |
| 49560 | Repair initial incisional or ventral hernia; reducible |
| 49561 | Repair initial incisional or ventral hernia; incarcerated or strangulated |
| 49565 | Repair recurrent incisional or ventral hernia; reducible |
| 49566 | incarcerated or strangulated |
| + 49568 | Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) |
- +49568 Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection. (List separately in addition to code for the incisional or ventral hernia.)
Umbilical
| Code | Description |
| 49580 | Repair umbilical hernia, younger than age 5 years; reducible |
| 49582 | incarcerated or strangulated |
| 49585 | Repair umbilical hernia, age 5 years or older; reducible |
| 49587 | incarcerated or strangulated |
These codes are defined by age, and by whether the hernia is reducible or incarcerated or strangulated.
Epigastric and other types
| Code | Description |
| 49570 | Repair epigastric hernia (eg, preperitoneal fat); reducible (separate procedure) |
| 49572 | incarcerated or strangulated |
| 49540 | Repair lumbar hernia |
| 49550 | Repair initial femoral hernia, any age; reducible |
| 49553 | incarcerated or strangulated |
| 49555 | Repair recurrent femoral hernia; reducible |
| 49557 | incarcerated or strangulated |
| 49590 | Repair spigelian hernia |