• My Account
    • Login
  • Contact Us

CodingIntel

Medical coding resources for physicians and their staff. CodingIntel was founded by consultant and coding expert Betsy Nicoletti.

  • Join Today
  • What is CodingIntel
    • About
    • Become a Member
    • FAQ
  • Free Resources
    • Free Resources Overview
    • Blog
    • Everyday Coding Q&A
    • Newsletter
    • Can I get paid
  • Coding Library
    • E/M Changes
    • How Physician Services Are Paid
    • In Person E/M
    • Prevention & Screening
    • Care Management & Remote Monitoring
    • Surgery, Modifiers & Global
    • Diagnosis Coding
    • New & Newsworthy
    • Speciality
    • Practice Management
  • Webinars
    • Webinars
    • Coding Guides
    • Quick Reference Sheets

Surgical Coding for Hernia Repair

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

 

Last revised June 13, 2022 - Betsy Nicoletti
Tags: general surgery_procedures

Wondering about the rules for HCC coding?

Wondering what the rules are for HCC coding, and where you can find them? This video answers your questions. The topic is important to medical practices because risk-adjusted diagnosis coding is part of Medicare Advantage contracts, many commercial contracts and Accountable Care Organizations (ACOs). Sign up for our monthly newsletter to download the whitepaper and watch the video.

Sign Up Now

Recommended Resource

You’ve coded it, but you still have to fight to get paid! We’ve partnered with Elizabeth Woodcock to give you the tools and strategies you need.

Find them here!

Latest Intel

Coding Principles for Practice Administrators | Webinar

Coding Principles for Practice … Read More...

CPT Coding for Obstetrical and Gynecological Procedures | Webinar

Who Runs the World? GIRLS!!: CPT Coding for … Read More...

Payment denials for unspecified codes

From the day coders got their first glimpse at … Read More...

Behavioral health coding compliance

Compliance Lessons from the OIG In March 2022, … Read More...

Browse By Categories

Browse Content

  • Articles
  • Coding Guides
  • Everyday Coding Q&A
  • Videos
  • Can I Get Paid to
  • Blog
  • Webinars

Tags

behavioral health_cpt codes behavioral health_E/M services care management category of service CMS updates Code sets and reimbursement compliance issues CPT codes for preventive services CPT updates critical care services dermatology_E/M services dermatology_essential resource dermatology_procedures E/M frequency data E/M medical decision making E/M overview E/M reference sheets E/M rule changes FQHC general surgery_diagnosis coding general surgery_E/M services general surgery_modifiers general surgery_procedures global surgery issues HCC diagnosis coding ICD-10 coding level of service_MDM level of service_time medicare incident-to and shared services minor procedures modifiers other E/M services Preventive and problem visits preventive services for medicare primary care_diagnosis coding primary care_E/M services primary care_essential resource primary care_modifiers primary care_other E/M services primary care_preventive services primary care_procedures remote physiologic monitoring screening and counseling for behavioral conditions teaching physician rules telehealth
  • What is CodingIntel
  • FAQs
  • Terms of Use
  • Privacy Policy
  • Contact

Our mission is to provide accurate, comprehensive, up-to-date coding information, allowing medical practices to increase revenue, decrease coding denials and reduce compliance risk. That's what coding knowledge can do.

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.

Copyright © 2022, CodingIntel
Privacy Policy