General Surgery Coding Alert

Question: I’m confused about how to use the CPT^® 2023 codes for anterior abdominal hernias. What factors should I use to choose the correct code?

Maryland Subscriber

Answer: The codes you’re referring to 49591-49596 (Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when performed, total length of defect(s) …) for initial hernia repair and 49613-49618 ((Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), recurrent, including implantation of mesh or other prosthesis when performed, total length of defect(s) …) for recurrent hernia repair.

CPT^® distinguishes these codes into the two families based on initial or recurrent. After that, the codes within each family are further distinguished based on whether the hernia is reducible or incarcerated/ strangulated, and repair size.

Each code descriptor includes a measurement that corresponds with the size of the presurgical defect. Here’s what you need to know about using the codes:

• Measure the distance between the farthest two points. If there are multiple non-contiguous defects separated by greater than or equal to 10 cm of intact tissue, the defect size is the sum of each individual hernia.
• If the patient has one hernia, you’ll simply use the documented measurement of the pre-surgical hernia’s longest length and report the code that best represents that size.
• If the total pre-surgery defect size is not in the documentation, you must default to the code that represents the smallest size, which is 49591 for initial repair or 49613 for recurrent repair.