Highlights
Providing free resources and useful informations for Physicians,
Office Managers, Medical Billers and Medical Coders
Medical Billing
Codes
Procedural
Codes for
Hernia Repair
for
Open or
Laparoscopic
Method
My Favorite Website is here!
Here are the medical billing codes that you can review for HERNIA Repair. Find what
medical billing codes fits your need.

I am hoping this information can help and save you time finding your medical billing
codes for hernia repair.

I have also embedded some videos on these procedures so you can have a better
understanding on how this procedure is performed by your surgeon.

Medical Billing and Coding TIPS:

What to Look for when coding for Hernia.

    1. Anatomical location of the hernia (epigastric, hiatal, inguinal, incisional,
    femoral, ventral, etc.)
    2. Age of the Patient (younger than 5 years old? older than 5 years old?)
    3. What Surgical Method was used - is it Laparoscopic or Open Procedure?
    3. Is the Hernia recurrent? or not?
    4. Is the Hernia incarcerated or strangulated?
    5. Was a placement of mesh being utilized?

Pointers:
1. I will recommend to use the proper location/site modifier whenever it is applicable
(eg. 50 for Bilateral, LT for Left Side and RT for Right Side)
2. Mesh placement is only billable for Ventral and Incisional Hernia
3. These CPT procedures has 90 days global period
4. Placement of Mesh CPT Code 49568 can only be billed together with Incisional
and Ventral Hernia repair per Medicare's NCCI Edits Manual.
5. Billable with an Assistant Surgeon (refer to your modifier for assist)

Hernia Procedure Codes:

****OPEN Surgical Hernia Repair

CPT Codes for Epigastric Hernia Repair
49570         Repair epigastric hernia (eg, preperitoneal fat); reducible (separate
procedure)         
49572         Repair epigastric hernia (eg, preperitoneal fat); incarcerated or
strangulated

CPT Codes for Femoral Hernia Repair
49550         Repair initial femoral hernia, any age; reducible         
49553         Repair initial femoral hernia, any age;
incarcerated or strangulated

49555         Repair recurrent femoral hernia; reducible
49557         Repair recurrent femoral hernia;
incarcerated or strangulated

CPT Codes for Hiatal Hernia Repair
43332         Repair, paraesophageal hiatal hernia (including fundoplication), via
laparotomy, except neonatal; without implantation of mesh or other prosthesis         
43333         Repair, paraesophageal hiatal hernia (including fundoplication), via
laparotomy, except neonatal; with implantation of mesh or other prosthesis

43334         Repair, paraesophageal hiatal hernia (including fundoplication), via
thoracotomy, except neonatal; without implantation of mesh or other prosthesis         
43335         Repair, paraesophageal hiatal hernia (including fundoplication), via
thoracotomy, except neonatal; with implantation of mesh or other prosthesis    

43336         Repair, paraesophageal hiatal hernia, (including fundoplication), via
thoracoabdominal incision, except neonatal; without implantation of mesh or other
prosthesis        
43337         Repair, paraesophageal hiatal hernia, (including fundoplication), via
thoracoabdominal incision, except neonatal; with implantation of mesh or other
prosthesis

CPT Codes for Incisional Hernia Repair
49560         Repair initial incisional or ventral hernia; reducible         
49561         Repair initial incisional or ventral hernia;
incarcerated or
strangulated
  

49565         Repair recurrent incisional or ventral hernia; reducible         
49566         Repair recurrent incisional or ventral hernia;
incarcerated or
strangulated

CPT Codes for Inguinal Hernia Repair
49495         Repair, initial inguinal hernia, 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, with or without hydrocelectomy; reducible         
49496         Repair, initial inguinal hernia, 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, with or without hydrocelectomy;
incarcerated or
strangulated  

49500         Repair initial inguinal hernia, age 6 months to younger than 5 years, with
or without hydrocelectomy; reducible         
49501         Repair initial inguinal hernia, age 6 months to younger than 5 years, with
or without hydrocelectomy;
incarcerated or strangulated         

49505         Repair initial inguinal hernia, age 5 years or older; reducible

49507         Repair initial inguinal hernia, age 5 years or older;
incarcerated or
strangulated

49520         Repair recurrent inguinal hernia, any age; reducible         
49521         Repair recurrent inguinal hernia, any age;
incarcerated or
strangulated   
      

49525         Repair inguinal hernia, sliding, any age

CPT Codes for Lumbar Hernia Repair
49540         Repair lumbar hernia

CPT Codes for Spigelian Hernia Repair
49590         Repair spigelian hernia

CPT Codes for Umbilical Hernia Repair
49580         Repair umbilical hernia, younger than age 5 years; reducible         
49582         Repair umbilical hernia, younger than age 5 years;
incarcerated or
strangulated         

49585         Repair umbilical hernia, age 5 years or older; reducible         
49587         Repair umbilical hernia, age 5 years or older;
incarcerated or
strangulated



**** Laparoscopic Surgical Hernia Repair

CPT Codes for Laparoscopic Epigastric Hernia Repair
49652         Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric
hernia (includes mesh insertion, when performed); reducible         
49653         Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric
hernia (includes mesh insertion, when performed);
incarcerated or strangulated

CPT Codes for Laparoscopic Hiatal Hernia Repair
43281         Laparoscopy, surgical, repair of paraesophageal hernia, includes
fundoplasty, when performed;
without implantation of mesh         
43282         Laparoscopy, surgical, repair of paraesophageal hernia, includes
fundoplasty, when performed;
with implantation of mesh


CPT Codes for Laparoscopic Incisional Hernia Repair
49654         Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion,
when performed); reducible
49655         Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion,
when performed);
incarcerated or strangulated

49656         Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh
insertion, when performed); reducible
49657         Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh
insertion, when performed);
incarcerated or strangulated


CPT Codes for Laparoscopic Inguinal Hernia Repair
49650         Laparoscopy, surgical; repair initial inguinal hernia         
49651         Laparoscopy, surgical; repair recurrent inguinal hernia


CPT Codes for Laparoscopic Spigelian Hernia Repair
49652         Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric
hernia (includes mesh insertion, when performed); reducible         
49653         Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric
hernia (includes mesh insertion, when performed);
incarcerated or strangulated

CPT Codes for Laparoscopic Umbilical Hernia Repair
49652         Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric
hernia (includes mesh insertion, when performed); reducible         
49653         Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric
hernia (includes mesh insertion, when performed);
incarcerated or strangulated

CPT Codes for Laparoscopic Ventral Hernia Repair
49652         Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric
hernia (includes mesh insertion, when performed); reducible         
49653         Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric
hernia (includes mesh insertion, when performed);
incarcerated or strangulated
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To better understand this procedure. Watch this video about the Open Procedure for
Inquinal Hernia Repair
To better understand this procedure. Watch this video about the Laparoscopic Hiatal
Hernia Repair
To better understand this procedure. Watch this video about the Laparoscopic Inguinal
Hernia Repair
CPT 2012 Code Book CPT is owned and a registered trademark of the American Medical Association.
CMS NCCI Edits Manual January 1, 2012
INTERESTING VIDEOS
ON HERNIA REPAIRS