Experts Answer FAQs about CPT Coding and New Hernia Repair Codes

Correct Current Procedural Terminology (CPT®)* coding is an important area for surgical practice improvement. However, annual changes in CPT codes and new surgical techniques can cause coding confusion.

This report provides answers to several frequently asked questions (FAQs) and the correct coding responses, including coding guidance for the new 2023 anterior abdominal hernia repair codes.

A surgeon performs open cholecystotomy, places a drain, and takes a biopsy of the gallbladder wall. Can the biopsy be separately reported?

No, the biopsy of the gallbladder wall is not separately reportable. The correct code to report for this operation is 47480, Cholecystotomy or cholecystostomy, open, with exploration, drainage, or removal of calculus (separate procedure).

What is the correct code to report an appendectomy with partial cecectomy and no anastomosis?

This operation would be reported with code 44950, Appendectomy.

If a surgeon repairs both an umbilical hernia and diastasis recti, can the diastasis measurement be included when choosing a code for reporting the hernia repair?

Diastasis recti (separation of abdominal muscles) is not a hernia defect and cannot be included in the measurement of a hernia sac for reporting a hernia repair code.

How do I report the repair of one 3 cm initial incisional hernia and one 3 cm recurrent incisional hernia that are separated by 2 cm of intact fascia when both hernias are reducible?

This hernia repair would be performed as a single unit with a measurement to include both defects and the bridge of intact fascia (i.e., 8 cm). The entire procedure would be treated as recurrent and reported with code 49615, Repair of anterior abdominal hernia(s) (i.e., epigastric, incisional, ventral, umbilical, spigelian), any approach (i.e., open, laparoscopic, robotic), recurrent, including implantation of mesh or other prosthesis when performed, total length of defect(s); 3 cm to 10 cm, reducible.

What if one 3 cm hernia is initial/incarcerated and the second 3 cm hernia is recurrent/reducible, separated by 2 cm of intact fascia?

This hernia repair would be performed as a single unit with a measurement to include both defects and the bridge of intact fascia (i.e., 8 cm). The entire procedure would be considered recurrent and strangulated and reported with code 49616, Repair of anterior abdominal hernia(s) (i.e., epigastric, incisional, ventral, umbilical, spigelian), any approach (i.e., open, laparoscopic, robotic), recurrent, including implantation of mesh or other prosthesis when performed, total length of defect(s); 3 cm to 10 cm, incarcerated or strangulated.

The rationale for this reporting guidance is that repair of these defects will typically include placement of a single piece of mesh. The higher level of repair (recurrent versus initial or incarcerated versus reducible) would dominate the work.

Why did the work relative value units (work RVUs) decrease significantly in 2023 for anterior abdominal hernia repair procedures?

The 2022 CPT codes for anterior abdominal hernia repair had a 90-day global period, and there were separate codes for reporting open and laparoscopic repair. The previous codeset had no option to discriminate for the size of the hernia to be repaired. The 2022 codes were deleted and replaced with new “any method” codes in 2023 that are based on hernia size and that have a 0-day global period.

The work RVUs for the new codes are not reduced, but rather, account only for the work on day of surgery. Postoperative care now is separately billable.

Therefore, it is important to verify the global period for the hernia repair code and to separately report all procedures and visits performed after the day of surgery. However, if these new 0-day global hernia repair codes are reported with another code that has a 90-day global period, then the entire operation is considered to have a 90-day global period.

Examples of changes in codes reported and work RVUs for 2022 versus 2023 are provided below.

Example 1

Patient with 2 cm reducible umbilical hernia

Same-day surgery Two office visits: Suture removal and visit at 6 weeks
Year	CPT Code and Short Descriptor	Procedure Work RVU	Visit Work RVU	Total Work RVU
2022	49585 Repair umbilical hernia, reducible	6.59	N/A	6.59
2023	49591 Repair initial hernia, <3 cm, reducible	5.96	99213 = 1.30 99212 = 0.70	7.96

Example 2

Patient with 8 cm reducible incisional hernia previously repaired with mesh that has failed

Operation includes hernia repair and removal and placement of mesh Patient stays overnight Three office visits: Suture/staple removal and visits at 6 weeks and 12 weeks
Year	CPT Code and Short Descriptor	Procedure Work RVU	Visit Work RVU	Total Work RVU
2022	49560 Open repair incisional hernia, reducible	11.92	N/A	16.80
	+49568 Implantation of mesh	4.88	N/A	16.80
	49654 Laparoscopic repair incisional hernia, reducible	13.76	N/A	13.76
2023	49615 Repair recurrent hernia, 3–10 cm, reducible	11.46	99238 = 1.50 99213 = 1.30	19.41
2023	+49623 Removal of total or near total non-infected mesh	3.75	99212 = 0.70 99212 = 0.70	19.41

Example 3

Patient with incarcerated midline Swiss cheese incisional hernias, total craniocaudal length of all defects is 12 cm

Operation includes hernia repair and placement of mesh and drain Patient goes home on postop day 2 with drain in place (2 midnights) Four office visits: Removal of drain, removal or sutures/staples, and visits at 6 and 12 weeks
Year	CPT Code and Short Descriptor	Procedure Work RVU	Visit Work RVU	Total Work RVU
2022	49561 Open repair initial incisional hernia, incarcerated	15.38	N/A	20.26
	+49568 Implantation of mesh	4.88	N/A	20.26
	49655 Laparoscopic repair incisional hernia, incarcerated	16.84	N/A	16.84
2023	49596 Repair initial hernia, >10 cm, incarcerated	18.67	99231 = 1.00 99238 = 1.50 99213 = 1.30 99213 = 1.30 99212 = 0.70 99212 = 0.70	25.17

Example 4

Obese diabetic patient with an incarcerated 14 cm incisional hernia previously repaired with mesh that has failed

Operation includes hernia repair, removal and placement of mesh, and component separation Patient goes home on postop day 3 with drain in place (3 midnights) Four office visits: Removal or sutures/staples at two visits and visits at 6 weeks and 12 weeks
Year	CPT Code and Short Descriptor	Procedure Work RVU	Visit Work RVU	Total Work RVU
2022	15734 Component separation	23.00	N/A	35.65
	49566 Open repair recurrent incisional hernia, incarcerated	7.77^†
	+49568 Implantation of mesh	4.88
2023	15734 Component separation	23.00	N/A	38.12
	49618 Repair recurrent hernia, >10 cm, incarcerated	11.34^†
	+49623 Removal of total or near total non-infected mesh	3.75
^†Multiple procedure payment reduction of 50%

Example 5

Patient with 4 cm reducible midline incisional hernia from a prior laparotomy for a colectomy and 4 cm irreducible parastomal hernia that does not require moving the ostomy location

Operation includes repair of two distinct hernias and placement of mesh Patient goes home on postop day 2 with drain in place (2 midnights) Four office visits: Removal of drain, removal or sutures/staples, and visits at 6 weeks and 12 weeks
Year	CPT Code and Short Descriptor	Procedure Work RVU	Visit Work RVU	Total Work RVU
2022	49561 Open repair initial incisional hernia, incarcerated	15.38	N/A	26.22
	49560 Open repair incisional hernia, reducible	5.96^†
	+49568 Implantation of mesh	4.88
2023	49622 Repair parastomal hernia, incarcerated	17.06	99231 = 1.00 99238 = 1.50 99213 = 1.30 99213 = 1.30 99212 = 0.70 99212 = 0.70	28.69
	49593 Repair initial hernia, 3–10 cm, reducible	5.13^†
^†Multiple procedure payment reduction of 50%

Learn More

The ACS collaborates with KarenZupko & Associates (KZA) on courses that provide the tools necessary to increase revenue and decrease compliance risk. These courses are an opportunity to sharpen your coding skills. You also will be provided online access to the KZA alumni website, where you will find additional resources and other FAQs about correct coding. Information about the courses can be accessed at karenzupko.com/general-surgery.

In addition, as part of the College’s ongoing efforts to help members and their practices submit clean claims and receive proper reimbursement, a coding consultation service—the ACS Coding Hotline—has been established for coding and billing questions. ACS members are offered five free consultation units (CUs) per calendar year. One CU is a period of up to 10 minutes of coding services time. Access the ACS Coding Hotline website at prsnetwork.com/acshotline.

Dr. Megan McNally is a surgical oncologist at Saint Luke’s Health System in Kansas City, MO, and assistant clinical professor in the Department of Surgery at the University of Missouri-Kansas City School of Medicine. She also is a member of the ACS General Surgery Coding and Reimbursement Committee and ACS advisor to the AMA CPT Editorial Panel.