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 49560—49566. The facility may bill for mesh in other cases, but there is not a separate physician charge.
- 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.
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