2023 coding changes of Hernia Repair Procedure

2023 coding changes of Hernia Repair Procedure

Definition of hernia:

A bulging of an organ or tissue through an abnormal opening.

What Is the Type of Hernia?

Inguinal

Femoral

Lumbar

Anterior abdominal Hernia

Parastomal hernia

Further categorize types of hernias as follows

1. Initial ( first time repair at this location)

2. Recurrent (repeated repair)

Clinical presentation of the hernia:

What is Reducible Hernia

When the contents of the hernia sac return to their normal location spontaneously or by gentle manipulation, the hernia is considered reducible.

1. What is Incarcerated or strangulated (cut blood supply)

The contents of an incarcerated hernia are trapped in the hernia sac and cannot be pushed back (reduced) through the defect. 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.

2. Inguinal Hernia:

1.  Identify the initial or recurrent hernia

2. Check the age of the patient

Preterm infant Initial Inguinal Hernia

· 49491 (preterm infant (younger than 37 weeks gestation at birth),

· 49492 incarcerated or strangulated

Fullterm Initial Inguinal Hernia:

· 49495 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

· 49496 incarcerated or strangulated

Age 6 months to younger than 5 years – initial Inguinal Hernia

· 49500 – reducible

· 49501- incarcerated or strangulated

Age 5 years or older – initial Inguinal Hernia

· 49505- reducible

· 49507- incarcerated or strangulated

Any age recurrent inguinal Hernia:

· 49520- reducible

· 49521- incarcerated or strangulated

3. Repair lumbar hernia 49540

4. Any age Initial femoral hernia

49550- reducible

49553- incarcerated or strangulated

Recurrent femoral hernia

· 49555- reducible

· 49557- incarcerated or strangulated

5a. Anterior abdominal Hernia – Initial

2023 coding changes of Hernia Repair Procedure as below

· Epigastric/incisional / Ventral/Umblical/Spigelian

· Any approach (Open or Laparoscopy)

· Including of implantation of mesh (deleted in 2023)

· Check Initial or Recurrent

· Identify the reducible or Incarcerated

· Check for the length of the defect as below

o Less than 3cm – 49591, 49592

o 3cm to 10cm – 49593, 49594

o Greater than 10cm – 49595, 49596

5b. Anterior abdominal Hernia – Recurrent

· Epigastric/incisional / Ventral/Umblical/Spigelian

· Any approach (Open or Laparoscopy)

· Including of implantation of mesh (deleted in 2023)

· Check the Initial or Recurrent

· Identify the reducible or Incarcerated

· Check for the length of the defect as below

o Less than 3cm – 49613, 49614

o 3cm to 10cm – 49615, 49616

o Greater than 10cm – 49617, 49618

6. Parastomal Hernia:

· Any approach (Open or Laparoscopy)

· Including implantation of mesh (deleted in 2023)

· Check Initial or Recurrent

· Identify the reducible or Incarcerated

· 49621, 49622

2023 Coding changes of Hernia Repair Procedure 

 
For 2023 coding changes of Hernia Repair Procedure, as summarized in this column. 

Delete codes 49560–49590, which describe open repair of anterior abdominal hernias Delete codes 49652–49657, which describe laparoscopic repair of anterior abdominal hernias. 

Delete add-on code 49568, which describes implantation of mesh for open ventral/incisional hernias and defects resulting from necrotizing soft tissue infection
Add 12 new codes (49591–49596 and 49613-49618)‡ to report anterior abdominal hernia repair by any approach (i.e., open laparoscopic, robotic), further by initial or recurrent hernia, further by total defect size, and further by reducible or incarcerated/strangulated

Add two new codes (49621–49622)‡ to report parastomal hernia repair by any approach (i.e., open laparoscopic, robotic), further divided by reducible or incarcerated/strangulated

Add one new add-on code (49623)‡ for removal of mesh/prosthesis at the time of initial or recurrent anterior abdominal hernia repair or parastomal hernia repair

Add one new code (15778)‡ for implantation of absorbable mesh or other prosthesis for delayed closure of external genitalia, perineum, and/or abdominal wall defect(s) due to soft tissue infection or trauma
Add two new add-on codes (15853–15854)‡ for removal of sutures/staples not requiring anesthesia, to be reported separately in addition to an E/M code