The introduction of CPT 2009 brought with it 6 new codes to report laparoscopic hernia repairs. Previously, you had to report such repairs using either so-called "unlisted procedure" codes or HCPCS Level II Temporary National codes. In either case, Medicare payors wouldn't recognize the available codes, thereby keeping laparoscopic hernia repairs off the ASC approved procedure list.

Each of the 6 new codes has been assigned to APC 0130. A "T" status indicator identifies the repairs as major procedures that are subject to the multiple-procedure discount when performed during the same session as any other major procedure(s).

The introduction of 49652 to 49657 has resulted in the deletion of temporary national (non-Medicare) codes S2075, S2076 and S2077 for laparoscopic hernia repairs and laparoscopic mesh placement. As of Jan. 1, 2009, these codes are no longer valid.

Codes 49652 to 49657 join established codes 49650 (Laparoscopy, surgical; repair initial inguinal hernia) and 49651 (???repair recurrent inguinal hernia [APC 0131]), which describe laparoscopic repair of initial and recurrent inguinal hernia, respectively.

Assign the appropriate code
To assign an appropriate laparoscopic hernia repair code, you must know the hernia type and location and, depending on the type and location, if the hernia is reducible and if this is the first repair at the same location. Generally, this information will be well documented in the physician's operative note.

The most familiar types of abdominal hernias are inguinal (49650-49651), umbilical (49652-49653), spigelian (49652-49653), epigastric (49652-49653) and incisional (49654 to 49657).

The term "ventral" in the descriptors for 49652 and 49653 can be confusing. An umbilical hernia, a spigelian hernia and an incisional hernia are all a type of ventral hernia in which abdominal contents protrude from a weakened area of the abdominal fascia. As used in the descriptors for 49652 and 49653, a ventral hernia refers to an umbilical or lateral ventral (spigelian) hernia. For a hernia at the site of a previous surgical incision, select from among the incisional hernia repair codes 49654 to 49657.

Reducible or incarcerated?
If the surgeon can manually push the contents of the hernia sac back through the fascial defect, the hernia is "reducible." Occasionally, the contents of the hernia sac become trapped in the opening caused by the fascial defect. Such "incarcerated" or "strangulated" hernias can't be reduced and may pose immediate, life-threatening danger. CPT frequently specifies separate codes to describe laparoscopic repair of reducible and incarcerated/strangulated hernias. For example, 49652 specifies repair of reducible ventral, umbilical, spigelian or epigastric hernias, while 49653 describes repair of incarcerated or strangulated hernias of identical types.

Codes for inguinal and incisional laparoscopic repairs distinguish between "initial" and "subsequent" hernia repairs. Report laparoscopic repair of an initial inguinal hernia with 49650 and repair of a recurrent inguinal hernia with 49651. An initial repair is just that: The first repair at a particular location. Because a hernia may recur at the same location, subsequent repairs are possible.

Per CPT, all laparoscopic hernia repairs include the placement of reinforcing mesh, when used. To reflect this, the AMA updated the descriptor for add-on code 49568 to specify, "Implantation of mesh or other prosthesis for open [emphasis added] incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection."

Although the descriptors for 49560 and 49561 don't specifically reference the use of mesh, its placement, when performed, is an integral part of all inguinal hernia repairs (whether open or laparoscopic) and therefore isn't coded separately.