Procedure code and Description
49560 Repair initial incisional or ventral hernia; reducible $760.86 0154 Hernia/Hydrocele Procedures $2,675.43 $1,466.02
49561 Repair initial incisional or ventral hernia; incarcerated or strangulated $961.44 0154 Hernia/Hydrocele Procedures $2,675.43 $1,466.02
49565 Repair recurrent incisional or ventral hernia; reducible $793.04 0154 Hernia/Hydrocele Procedures $2,675.43 $1,466.02
49566 Repair recurrent incisional or ventral hernia; incarcerated or strangulated $969.67 0154 Hernia/Hydrocele Procedures $2,675.43 $1,466.02
+495681 Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) $277.46 NA NA Packaged into Payment for Other Services Packaged Service/Item
49652 Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); reducible $768.37 0132 Level III Laparoscopy $5,479.13 $3,002.32
49653 Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); incarcerated or strangulated $958.94 0132 Level III Laparoscopy $5,479.13 $3,002.32
49654 Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); reducible $873.49 0132 Level III Laparoscopy $5,479.13 $3,002.32
49655 Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); incarcerated or strangulated $1,067.28 0132 Level III Laparoscopy $5,479.13 $3,002.32
49656 Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); reducible $949.29 0132 Level III Laparoscopy $5,479.13 $3,002.32
49657 Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); incarcerated or strangulated $1,364.76 0132 Level III Laparoscopy $5,479.13 $3,002.32
49566 Repair recurrent incisional or ventral 27.76 $ 944.48 $ 2,429.11 $1,363.05 hernia; incarcerated or strangulated
49659 Unlisted laparoscopy procedure, hernioplasty, N/A N/A $2,730.07 N/A herniorrhaphy, herniotomy
49585 Repair umbilical hernia, age 5 years or 13.22 $ 449.78 $2,429.11 $1,363.05 older; reducible
49587 Repair umbilical hernia, age 5 years or 14.15 $ 481.43 $2,429.11 $1,363.05 older; incarcerated or strangulated
49505 Repair initial inguinal hernia, age 5 years 15.45 $ 525.66 $2,429.11 $1,363.05 or over; reducible
49507 Repair initial inguinal hernia, age 5 years 17.37 $ 590.98 $2,429.11 $1,363.05 or over; incarcerated or strangulated
49520 Repair recurrent inguinal hernia, any age; 18.71 $ 636.57 $2,429.11 $1,363.05 reducible
49521 Repair recurrent inguinal hernia, any age; 21.18 $ 720.61 $2,429.11 $1,363.05 incarcerated or strangulated
49525 Repair inguinal hernia, sliding, any age 16.97 $ 577.37 $2,429.11 $1,363.05
Hernia Repair
11008 Removal of mesh in abdominal wall for infection
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
49525 Repair inguinal hernia, sliding, any age
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
49568 Implantation of mesh or other prosthesis for incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral 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
49650 Laparoscopy, surgical; repair initial inguinal hernia
49651 Laparoscopy, surgical; repair recurrent inguinal hernia
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
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
49659* Unlisted lap procedure, hernioplasty, hernioorrhaphy, herniotomy
39501 Repair, laceration of diaphragm, any approach N/A Inpatient Only Inpatient Only 39503 Repair, neonatal diaphragmatic hernia, with or without chest tube insertion and with or without creation of ventral hernia
39540 Repair, diaphragmatic hernia (other than neonatal), traumatic; acute
39541 Repair, diaphragmatic hernia (other than neonatal), traumatic; chronic
39561 Resection, diaphragm; with complex repair (eg, prosthetic material, local muscle flap)
43282 Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; with implantationof mesh
43333 Repair, paraesophageal hiatal hernia (including fundoplication), via laparotomy, except neonatal; with implantation of mesh or other prosthesis
43335 Repair, paraesophageal hiatal hernia (including fundoplication), via thoracotomy, except neonatal; with 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
Potential Procedures Using SurgiMend® in Diaphragmatic Hernia Repair – Physician Fee Schedule – Facility
CPT Code Code Description Work Relative Value Unit 2017 National Medicare Payment Rate -Facility
39501 Repair, laceration of diaphragm, any approach 13.98 $881.43
39503 Repair, neonatal diaphragmatic hernia, with or without chest tube insertion and with or without creation of ventral hernia 108.91 $6,175.01
39540 Repair, diaphragmatic hernia (other than neonatal), traumatic; acute 14.57 $902.60
39541 Repair, diaphragmatic hernia (other than neonatal), traumatic; chronic 15.75 $980.84
39561 Resection, diaphragm; with complex repair (eg, prosthetic material, local muscle flap) 19.99 $1,291.28
43282 Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; with implantation of mesh 30.10 $1,807.71
43333 Repair, paraesophageal hiatal hernia (including fundoplication), via laparotomy, except neonatal; with implantation of mesh or other prosthesis 21.46 $1,318.55
43335 Repair, paraesophageal hiatal hernia (including fundoplication), via thoracotomy, except neonatal; with implantation of mesh or other prosthesis 23.97 $1,397.86
43337 Repair, paraesophageal hiatal hernia, (including fundoplication), via thoracoabdominal incision, except neonatal; with implantation of mesh or other prosthesis 27.65 $1,692.51
Parastomal Hernia Repair
44346 Revision of colostomy; with repair of paracolostomy hernia (separate procedure)
Hiatal Hernia Repair 39540 Repair, diaphragmatic hernia (other than neonatal), traumatic; chronic
39541 Repair, diaphragmatic hernia (other than neonatal), traumatic; chronic
| CPT Code | CPT Description | ICD -9 Procedure |
| 49495 | Repair initial inguinal hernia, under age 6 months, with or without hydrocelectomy; reducible |
5300 |
| 49496 | incarcerated or strangulated | 5300 |
| 49500 | Repair initial inguinal hernia, age 6 months to under 5 years, with or without hydrocelectomy; reducible |
5300 |
| 49501 | incarcerated or strangulated | 5300 |
| 49505 | Repair initial inguinal hernia, age 5 years or over; reducible | 5300 |
| 49507 | incarcerated or strangulated | 5300 |
| 49520 | Repair recurrent inguinal hernia, any age; reducible | 5300 |
| 49521 | incarcerated or strangulated | 5300 |
| 49525 | Repair inguinal hernia; sliding, any age | 5300 |
| 49540 | Repair lumbar hernia | 539 |
| 49550 | Repair initial femoral hernia, any age; reducible | 5329 |
| 49553 | incarcerated or strangulated | 5329 |
| 49555 | Repair recurrent femoral hernia; reducible | 5329 |
| 49557 | incarcerated or strangulated | 5329 |
| 49560 | Repair initial incisional or ventral hernia; reducible | 5351 |
| 49561 | incarcerated or strangulated | 5351 |
| 49565 | Repair recurrent incisional or ventral hernia; reducible | 5351 |
| 49566 | incarcerated or strangulated | 5351 |
| 49568 | Implantation of mesh or other prosthesis for incisional or ventral hernia repair (List separately in addition to code for the incisional or ventral hernia repair) |
5351 (49565) |
| 49570 | Repair epigastric hernia (e.g. Preperitoneal fat); reducible (separate procedure) |
5359 |
| 49572 | incarcerated or strangulated | 5359 |
| 49580 | Repair umbilical hernia, under age 5 years; reducible | 5359 |
| 49582 | incarcerated or strangulated | 5359 |
| 49585 | Repair umbilical hernia, age 5 years or over; reducible | 5349 |
| 49587 | incarcerated or strangulated | 5349 |
| 49590 | Repair spigelian hernia | 5359 |
| 49600 | Repair of small omphalocele, with primary closure | 5349 |
| 49605 | Repair of large omphalocele or gastroschisis; with or without prosthesis |
5341 |
| 49606 | with removal of prosthesis, final reduction and closure, in operating room |
5341 |
| 49610 | Repair of omphalocele (Gross type operation); first stage | 5349 |
| 49611 | second stage | 5349 |
Hernia Repair
Note that different types of hernia may use the same ICD-10-PCS procedure code if the repair technique is the same.
The type of hernia being repaired is differentiated by the ICD-10-CM diagnosis codes, not necessarily by the ICD-10-PCS procedure codes.
CHARACTER DESCRIPTION
1: Section Because hernia repair constitutes surgery, the appropriate section is 0-Medical and Surgical.
2: Body System
Most hernia repairs are assigned to the body systems for Anatomical Regions, either W-Anatomical Regions, General (eg, umbilical hernia) or Y-Anatomical Regions, Lower Extremities (eg, inguinal hernia, femoral hernia). Repair of diaphragmatic hernias is assigned to B-Respiratory System (eg, hiatal hernia) because the diaphragm is classified to this body system for coding purposes.
3: Root Operation
The two main root operations for hernia repair are Q-Repair, which is assigned when mesh is not used, and U-Supplement, which is assigned when mesh is used. Note that a code using root operation U-Supplement stands by itself as a hernia repair procedure and no additional code is required or assigned to capture the repair or use of mesh.
4: Body Part
On their given code tables, specific body part values are available for diaphragm, abdominal wall, inguinal region, femoral region, and other lower extremity areas.
5: Approach
Hernia repair performed by incising the tissue layers to expose the hernia sac uses 0-Open. Laparoscopic hernia repair uses 4-Percutaneous Endoscopic.
6: Device
For hernia repair without mesh, Z-No Device is used. For hernia repair with mesh, mesh is considered a device. There are three types of mesh: 1) Most mesh is made of synthetic materials such as polypropylene, polyester, and PTFE; 2) Some mesh is bioengineered from donated human tissue, such as from cadavers, and; 3) Some mesh is bioengineered from animal tissue such as bovine and porcine tissue (eg, PermacolTM Surgical Implant). Although there are three types of mesh, there are currently only two options for the device value. Synthetic meshes use J-Synthetic Substitute. Meshes made of either human and animal tissues currently use K-Nonautologous Tissue.5
7: Qualifier Qualifiers add further information to the code but typically, Z-No Qualifier is used.
Abdominal Wall Repair
In general, abdominal wall repair uses the same coding principles and the same code values as hernia repair. An abdominal wall repair is differentiated from a hernia repair by the ICD-10-CM diagnosis codes, not necessarily by the ICD-10-PCS procedure codes.
Abdominal wall repair is not coded separately when an associated procedure is performed on an internal organ, because procedural steps necessary to close an operative site are considered integral.
CHARACTER DESCRIPTION
2: Body System Abdominal wound repair is coded to body system W-Anatomical Regions, General.
3: Root Operation The two main root operations for abdominal wall repair are Q-Repair, which is assigned when mesh is not used, and U-Supplement, which is assigned when mesh is used.
5: Approach Abdominal wall repair that involves closure of multiple layers below the skin uses 0-Open.7
6: Device For abdominal wall repair without mesh, Z-No Device is used. For abdominal wall repair with mesh, either J-Synthetic Substitute or K-Nonautologous Tissue is used
Component Separation
Component separation allows primary closure of large abdominal defects, by separating and releasing the fascial and muscle layers in the abdominal wall. When performed with hernia repair, it is coded separately.
CHARACTER DESCRIPTION
2: Body System Because component separation involves releasing muscles, the body system is K-Muscles.9
3: Root Operation The root operation for component separation is N-Release.9
4: Body Part The body part is K-Abdomen Muscle, Right and L-Abdomen Muscle, Left. Release is performed on both sides of the abdomen so two codes are assigned, one with body part K and one with body part
Facility ICD-9-CM Procedure Codes & Descriptors
34.81 Excision of lesion or tissue of diaphragm 163-165, 515-517
42.7 Esophagomyotomy 133-134, 326-328, 820-822, 826-828, 907-909, 957
44.67 Laparoscopic procedures for creation of esophagogastric 326-328, 907-909, 957, 987-989 sphincteric competence
46.1 [series] Colostomy 329-331, 907-909, 957
46.2 [series] Ileostomy 329-331, 907-909, 957
46.40 [series] Revision of intestinal stoma 347-349, 907-909, 957
46.5 [series] Closure of intestinal stoma 344-346, 907-909, 957
53.00 Unilateral repair of inguinal hernia, not otherwise specified 350-352, 987-989
53.01 Other and open repair of direct inguinal hernia 350-352, 987-989
53.03 Other and open repair of direct inguinal hernia with graft or prosthesis 350-352, 987-989
53.04 Other and open repair of indirect inguinal hernia with graft or prosthesis 350-352, 987-989
53.05 Unilateral repair of inguinal hernia with graft or prosthesis, not otherwise specified 350-352, 987-989
53.14 Other and open bilateral repair of direct inguinal hernia with graft or prosthesis 350-352, 987-989
53.15 Other and open bilateral repair of indirect inguinal hernia with graft or prosthesis 350-352, 987-989
53.16 Other and open bilateral repair of inguinal hernia, one direct and one indirect, 350-352, 987-989 with graft or prosthesis
53.17 Bilateral inguinal hernia repair with graft or prosthesis, not otherwise specified 350-352, 987-989
53.71 Laparoscopic repair of diaphragmatic hernia, abdominal approach 163-165, 326-328, 907-909, 957
53.72 Other and open repair of diaphragmatic hernia, abdominal approach 163-165, 326-328, 907-909, 957
53.75 Repair of diaphragmatic hernia, abdominal approach, not otherwise specified 163-165, 326-328, 907-909, 957
53.83 Laparoscopic repair of diaphragmatic hernia, with thoracic approach 163-165, 326-328, 907-909, 957
53.84 Other and open repair of diaphragmatic hernia, with thoracic approach 163-165, 326-328, 907-909, 957 MS-DRG
53.41 Repair of hernia with graft or prosthesis 353-355, 987-989
53.59 Repair of other hernia of anterior abdominal wall 353-355
53.61 Other open incisional hernia repair with graft or prosthesis 353-355, 907-909, 957
53.62 Laparoscopic incisional hernia repair with graft or prosthesis 353-355, 907-909, 957
53.63 Other laparoscopic repair of other hernia of anterior abdominal wall with 353-355 graft or prosthesis
