Be Prepared: New Hernia Repair Codes Coming Soon

EDITOR’S NOTE: The Current Procedural Terminology (CPT®) changes for 2023 were released on Sept. 12. This release from the American Medical Association (AMA) includes 225 new codes, 75 deletions, and 93 revisions. The update totals 393 editorial changes.

There has been a change in the CPT codes for hernia repair, which have been revised for 2023. There is a new section note before CPT 49491, which states that hernia repair codes are categorized primarily by type of hernia (inguinal, femoral, lumbar, omphalocele, anterior abdominal, parastomal).

There are 15 new codes under femoral hernia, abdominal hernia, and parastomal hernia repairs. The new codes identify the length of the defect and if the hernia is reducible. There is an illustration after 49600 that depicts measuring anterior abdominal defects. The description states that the total length of the defect corresponds to the maximum width or height of an oval drawn around 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, the total defect size is the sum of each defect measured individually. This information is important to convey to your surgeons, physician assistants, and nurse practitioners who may be documenting this condition. This documentation will be important for assigning accurate CPT codes.

Another new code, an add-on code, is 49623, for the total removal or near-total removal of non-infected mesh or other prosthesis at the time of initial or recurrent anterior abdominal or parastomal hernia repair, any approach. Anterior abdominal hernia types include epigastric, incisional, ventral, umbilical, and spigelian. To remove infected mesh, use 11008, which is also an add-on code.

Another change is that the CPT codes will include the implantation of mesh. The CPT add-on code 49568 has been deleted. Under the Ambulatory Payment Classification (APC), this CPT code was not reimbursed.

Another task to prepare for 2023 is to analyze the revenue impact created by the change in the CPT codes. Like the analysis of the deletion of 49568, review the impact that other deletions will have on your revenue.

Utilize Addendum B from the 2023 Outpatient Prospective Payment System (OPPS) to understand the impact of the new CPT codes with an estimated volume on the bottom line (keep in mind that Addendum B has not yet been published).

The 2023 CPT codes will be effective Jan. 1, 2023. There is still time to complete documentation education with the medical staff.