This month’s edition of “Spotlight on CPT” will cover
information regarding the coding for anterior abdominal and parastomal hernia
repairs. This section of CPT underwent
some major changes for 2023. Let’s begin
by identifying anterior abdominal hernias.
These are hernias that were previously classified as ventral.
Incisional, epigastric, umbilical or spigelian.
The change resulted in the deletion of two code ranges:
49560-49590 (open) and 49652-49657 (laparoscopic). The code range for the recategorized anterior
abdominal hernias is 49591 - 49518.
Only one code from the 49591-49618 series may be
assigned. Total defect size will be one
of the factors in determining code selection.
The total defect size is based on the measurement of one or more
anterior abdominal hernias. The
measurement should be determined prior to opening the hernia as fascial
retraction may occur leading to an inaccurate measurement. This measurement should be the maximum
craniocaudal or transverse distance between the outer margins of all the
anterior abdominal hernias that are being repaired. For example, a patient may be described as
having “Swiss cheese” defects and if multiple hernias are repaired during the
same encounter, measurement should begin at the superior aspect of the upper
defect to the inferior aspect of the lowest defect. The size distinctions begin as less than 3
cm, 3 cm-10 cm, and finally greater than 10 cm.
As noted, total defect size is one component of choosing the
correct anterior abdominal hernia repair code.
The other two components are whether the hernia is initial or recurrent,
and if the hernia is reducible or incarcerated/strangulated. Notice that it no longer matters which
approach is used for the repair as these codes capture any approach used (open,
laparoscopic, robotic). Likewise, there
is no separate code assignment for the use of mesh or any other prosthetic device
if they are used in conjunction with the repair. The new code series is inclusive of mesh or
other prosthetic devices when performed.
49591 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);
less than 3 cm, reducible
49592 less than 3 cm, incarcerated or
strangulated
49593 3 cm to 10 cm, reducible
49594 3 cm to 10 cm, incarcerated or
strangulated
49595 greater than 10 cm, reducible
49596 greater than 10 cm, incarcerated
or strangulated
49613 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); less than 3
cm, reducible
49614 less
than 3 cm, incarcerated or strangulated
49615 3 cm to 10 cm, reducible
49616 3 cm to 10 cm, incarcerated or
strangulated
49617 greater than 10 cm, reducible
49618 greater than 10 cm, incarcerated
or strangulated
If inguinal, femoral, lumbar, parastomal hernias or omphaloceles
are repaired during the same operative episode as an anterior abdominal hernia,
they may be separately coded. Be sure to
assign modifier 59 as appropriate.
You may be wondering since only one code may be assigned for
the repair of anterior abdominal hernias what the correct reporting would be if
both reducible and incarcerated/strangulated hernias are repaired at the same
encounter. In that type of scenario,
assign a code for incarcerated/strangulated.
For example, if there is a 3 cm reducible incisional hernia, and a 5 cm
incarcerated incisional hernia (both initial), and they are separated by 3 cm,
then the correct code to be assigned would be 49596 (3+5+3=11 cm total defect
size, initial, and incarcerated).
Parastomal hernias occur around colostomies or ileostomies
when the intestines bulge outward around a stomal opening. The new codes for repair of parastomal
hernias are noted below. Please be aware
that these code are for both initial and recurrent parastomal hernias and
include the use of mesh or other prothesis when performed. The repair codes differ between parastomal
hernias that are reducible and those that are incarcerated/strangulated.
49621 Repair of parastomal hernia, any approach (ie, open,
laparoscopic, robotic), initial
or recurrent, including implantation of mesh or other prosthesis, when performed;
reducible
49622 incarcerated
or strangulated
The final change to be aware of in this section is the new
add-on code 49623. This code is for the
removal of total or near total non-infected mesh or other prosthesis at the
time of initial or recurrent anterior abdominal hernia or parastomal hernia
repair. Again, any approach may be used
(open, laparoscopic, or robotic). Do not
use this code when infected mesh is removed.
Instead assign 11008.
Now, light has been shed on coding anterior abdominal
hernias.
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About the Author
Dianna Foley, RHIA, CCS, CHPS, CDIP, is
OHIMA's Education Coordinator. Dianna has been an HIM
professional for over 20 years. She progressed through the ranks of coder,
department supervisor, and department director, to her current role as a
coding consultant. She previously served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati and holds RHIA, CHPS, CDIP and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and is a presenter on coding topics at the national, state, and regional levels. Dianna mentors new AHIMA members and also provides monthly educational lectures to coders and clinical documentation specialists.
