| CPT code | Descriptor | 2017 total RVU |
|---|---|---|
| 49520 | Repair recurrent inguinal hernia, any age; reducible | 18.27 |
| 49521 | Repair recurrent inguinal hernia, any age; incarcerated or strangulated | 20.72 |
| 49525 | Repair inguinal hernia, sliding, any age | 16.56 |
| 49540 | Repair lumbar hernia | 19.47 |
There is no cure for symptomatic bilateral hernias except surgery. However, if the bilateral hernias are not bothering you, they may not require any treatment. In painful cases, hernias can be repaired either by a herniorrhaphy or a hernioplasty.
prostheses is not separately reported.” Therefore, CPT code 49568 (mesh implantation) should not be reported separately with CPT code 49505 (inguinal hernia repair). The hernia repair codes in this section are categorized primarily by the type of hernia (inguinal, femoral, incisional, etc.).
Surgery may not be needed if the hernia is small and if one does not experience any symptoms. However, consultation with the doctor is a must before one decides on any action plan. Surgery in children: In many cases, a child suffering from inguinal hernia will need surgery to get it corrected.
Part 1 Part 1 of 3: Treating Hernia Pain at Home
Codes 49491–49651 describe unilateral hernia repair procedures; if performed bilaterally (same approach, same condition), append modifier 50 Bilateral procedure to the appropriate code to report bilateral hernia repair (e.g., bilateral recurrent inguinal hernias).
ICD-10-CM Code for Unilateral inguinal hernia, without obstruction or gangrene, recurrent K40. 91.
ICD-10-CM Code for Bilateral inguinal hernia, without obstruction or gangrene, recurrent K40. 21.
CPT® Code 49654 in section: Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed)
CPT® lists only three codes for laparoscopic hernia repair, including two codes for inguinal hernia repair (49650, any initial repair and 49561, all recurrent repairs) and a single unlisted-procedure code, 49659, to cover laparoscopic repairs of all other hernia types, regardless of patient age or initial/recurrent, ...
9 Unspecified abdominal hernia without obstruction or gangrene.
Bilateral inguinal hernia, with obstruction, without gangrene, not specified as recurrent. K40. 00 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM K40.
K40.0K40. 0 Bilateral inguinal hernia, with obstruction, without gangrene.
K40. 90 - Unilateral inguinal hernia, without obstruction or gangrene, not specified as recurrent. ICD-10-CM.
CPT® Code 44005 in section: Incision Procedures on the Intestines (Except Rectum)
Answer: Repair of an umbilical hernia via an open approach is coded as 49585. Mesh placement may not be reported separately. Per CPT, mesh placement is only reported separately with repair of open Incisional hernias.
CPT® Code 49561 in section: Repair initial incisional or ventral hernia.
1. Size of hernia. Large inguinal hernias recur twice as often as small ones because of overstretching with attenuation and destruction of tissues normally used for repair of the hernia.
Inguinal hernias are further subdivided into direct and indirect. An indirect hernia occurs when abdominal contents protrude through the internal inguinal ring and into the inguinal canal. This occurs lateral to the inferior epigastric vessels. The hernia contents may extend into the scrotum.
An inguinal hernia is a bulging of the contents of the abdomen through a weak area in the lower abdominal wall. Inguinal hernias can occur at either of two passages through the lower abdominal wall, one on each side of the groin. These passages are called inguinal canals.
An incarcerated inguinal hernia is a hernia that becomes stuck in the groin or scrotum and cannot be massaged back into the abdomen. An incarcerated hernia is caused by swelling and can lead to a strangulated hernia, in which the blood supply to the incarcerated small intestine is jeopardized.
Voilà, you’re done. If it’s open, you have a bit more work to do, so turn to code range 49491–49611 for open hernia repair.
Another factor that determines correct coding is the clinical presentation of the hernia. When the contents of the hernia sac return to their normal location spontaneously or by gentle manipulation, the hernia is considered reducible. While moving the contents may make the hernia appear smaller or disappear, the weakened tissue still needs to be repaired to avoid recurrence of the hernia.
Add-on code +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) can only be reported separately with codes 49560–49566 for incisional or ventral hernia repair and debridement codes 11040–11006.
Do not use add-on code +11008 Removal of prosthetic material or mesh, abdominal wall for infection (eg, for chronic or recurrent mesh infection or necrotizing soft tissue infection) (List separately in addition to code for primary procedure) to report mesh removal during hernia repair. Although it describes mesh removal, this code can only be used with 10180 Incision and drainage, complex, postoperative wound infection and debridement codes 11004–11006.
Surgery is directed at permanently closing off the orifice through which the abdominal contents protrude, after returning them to the abdominal cavity. Usually, an incision is made over the hernia and the hernia sac is dissected from any surrounding structures.
Incarcerated hernias are more worrisome because they run a greater likelihood of becoming strangulated, which is when the blood supply to an incarcerated hernia is cut off as the vessels pass through the neck of the hernia. This is dangerous, due to the risk of gangrene when tissues die, and can be life-threatening if it isn’t treated.
This abnormal protrusion occurs due to a weak spot in the surrounding muscle or connective tissue (fascia). In some cases, only an empty sac protrudes through, but if the defect is large enough, the hernia sac can contain abdominal contents, typically part of the intestine.
The CPT code for this procedure is in the range of 49491 to 49525.
In bilateral inguinal hernia, the bulging tissues are found on both the inguinal canals. The incision is made near the abdominal region. The CPT code used for this process is 49650.
Inguinal hernia repair is the surgical procedure of fixing the bulging tissues of lower abdomen back by stitching. This condition is usually observed in the groin area or near groin area (commonly in men). The other names of this procedure are inguinal herniorrhaphy and open hernia repair.
The last update in hernia coding was in 2009.
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.
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.
CPT ® code 49659, unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy is reported when a CPT ® code does not exist for the type of repair performed.
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.
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.
As identified in Table 1 only the codes for open repair of inguinal hernias (49491–49525) or umbilical hernias (49580–49587) have distinct codes based on the age of the patient. Until 1994, separate repair codes were used to report incarcerated hernias and strangulated hernias. These two patient presentations were combined in the 1994 CPT revision. Until 1994, separate codes were used to report different approaches to hernia repair, such as an inguinal approach versus an anterior extraperitoneal approach (Henry) for a femoral hernia repair. Beginning in 1994, all open hernia repair codes were categorized as reducible or incarcerated/strangulated, except for the rare lumbar hernia repair (49540) or rare spigelian hernia repair (49590).
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 in conjunction with 11004–11006, 49560–49566)
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; incarcerated or strangulated
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; reducible. 6.20. 10.93. 49496.
Hernia repair includes isolation and dissection of the hernia sac, reduction of intraperitoneal contents, fascial repair, and soft tissue closure. In 1993, the ACS submitted a code change proposal to the American Medical Association CPT Editorial Panel to revise hernia coding in 1994 based on several variables, including the following:
A hernia should be considered incarcerated if, at the time of the operation, it contains viscera that the surgeon must manually reduce. It should be considered strangulated if the incarcerated contents have evidence of ischemia due to compression of the vascular supply.
Code 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), may be reported only once in addition to the open incisional or ventral hernia repair code (49560–49566), as applicable. Medicare rules do not permit appending modifier 50 to code 49568 for bilateral hernia repair. Code 49568 includes the work of placing the mesh, independent of the size of mesh used. It is the facility’s responsibility to report the type and size of mesh used; the surgeon only reports code 49568 .