Extensive changes have been made to the CPT codes for reporting hernia repairs effective January 1, 2023.  This section needed to be revamped to reflect current clinical practices utilized in these procedures.

Here is a quick peek at the structure of the new codes:

Key points include:

• The new codes identify anterior abdominal hernia repairs by initial vs. recurrent and incarcerated vs. reducible, and by size of defect.
• Procedures that are performed by open, laparoscopic, and robotic approach are all represented in the new codes.
• CPT code 49568 for reporting implantation of mesh has been deleted. The work associated with mesh implantation is now incorporated in the work reported with these new codes.
• All hernias described as epigastric, incisional, ventral, umbilical, and spigelian are now coded with these new codes for anterior abdominal hernia repairs.
• Hernia repair procedures performed on inguinal, femoral, parastomal, and pelvic floor hernias have their own codes and are not reported with these new codes. If inguinal, femoral, lumbar, omphalocele, or parastomal hernias are repaired at the same operative session as an anterior abdominal hernia, they may be coded separately with a modifier -59 (when appropriate).

Documentation Tip!  Hernia measurements are performed either in the transverse or craniocaudal dimension. The total length of the defect(s) corresponds to the maximum width or height of an oval drawn to encircle the outer perimeter of all repaired defects. If the defects are not contiguous and are separated by greater than or equal to 10 cm of intact fascia, total defect size is the sum of each defect measured individually.