April 10, 2023
Correct Current Procedural Terminology (CPT®)* coding is an important area for surgical practice improvement. However, annual changes in CPT codes and new surgical techniques can cause coding confusion.
This report provides answers to several frequently asked questions (FAQs) and the correct coding responses, including coding guidance for the new 2023 anterior abdominal hernia repair codes.
No, the biopsy of the gallbladder wall is not separately reportable. The correct code to report for this operation is 47480, Cholecystotomy or cholecystostomy, open, with exploration, drainage, or removal of calculus (separate procedure).
This operation would be reported with code 44950, Appendectomy.
Diastasis recti (separation of abdominal muscles) is not a hernia defect and cannot be included in the measurement of a hernia sac for reporting a hernia repair code.
This hernia repair would be performed as a single unit with a measurement to include both defects and the bridge of intact fascia (i.e., 8 cm). The entire procedure would be treated as recurrent and reported with code 49615, Repair of anterior abdominal hernia(s) (i.e., epigastric, incisional, ventral, umbilical, spigelian), any approach (i.e., open, laparoscopic, robotic), recurrent, including implantation of mesh or other prosthesis when performed, total length of defect(s); 3 cm to 10 cm, reducible.
This hernia repair would be performed as a single unit with a measurement to include both defects and the bridge of intact fascia (i.e., 8 cm). The entire procedure would be considered recurrent and strangulated and reported with code 49616, Repair of anterior abdominal hernia(s) (i.e., epigastric, incisional, ventral, umbilical, spigelian), any approach (i.e., open, laparoscopic, robotic), recurrent, including implantation of mesh or other prosthesis when performed, total length of defect(s); 3 cm to 10 cm, incarcerated or strangulated.
The rationale for this reporting guidance is that repair of these defects will typically include placement of a single piece of mesh. The higher level of repair (recurrent versus initial or incarcerated versus reducible) would dominate the work.
The 2022 CPT codes for anterior abdominal hernia repair had a 90-day global period, and there were separate codes for reporting open and laparoscopic repair. The previous codeset had no option to discriminate for the size of the hernia to be repaired. The 2022 codes were deleted and replaced with new “any method” codes in 2023 that are based on hernia size and that have a 0-day global period.
The work RVUs for the new codes are not reduced, but rather, account only for the work on day of surgery. Postoperative care now is separately billable.
Therefore, it is important to verify the global period for the hernia repair code and to separately report all procedures and visits performed after the day of surgery. However, if these new 0-day global hernia repair codes are reported with another code that has a 90-day global period, then the entire operation is considered to have a 90-day global period.
Examples of changes in codes reported and work RVUs for 2022 versus 2023 are provided below.
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Year |
CPT Code and Short Descriptor |
Procedure Work RVU |
Visit Work RVU |
Total Work RVU |
2022 |
49585 Repair umbilical hernia, reducible |
6.59 |
N/A |
6.59 |
2023 |
49591 Repair initial hernia, <3 cm, reducible |
5.96 |
99213 = 1.30 |
7.96 |
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Year |
CPT Code and Short Descriptor |
Procedure Work RVU |
Visit Work RVU |
Total Work RVU |
2022 |
49560 Open repair incisional hernia, reducible |
11.92 |
N/A |
16.80 |
+49568 Implantation of mesh |
4.88 |
|||
49654 Laparoscopic repair incisional hernia, reducible |
13.76 |
N/A |
13.76 |
|
2023 |
49615 Repair recurrent hernia, 3–10 cm, reducible |
11.46 |
99238 = 1.50 |
19.41 |
+49623 Removal of total or near total non-infected mesh |
3.75 |
99212 = 0.70 |
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Year |
CPT Code and Short Descriptor |
Procedure Work RVU |
Visit Work RVU |
Total Work RVU |
2022 |
49561 Open repair initial incisional hernia, incarcerated |
15.38 |
N/A |
20.26 |
+49568 Implantation of mesh |
4.88 |
|||
49655 Laparoscopic repair incisional hernia, incarcerated |
16.84 |
N/A |
16.84 |
|
2023 |
49596 Repair initial hernia, >10 cm, incarcerated |
18.67 |
99231 = 1.00 |
25.17 |
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Year |
CPT Code and Short Descriptor |
Procedure Work RVU |
Visit Work RVU |
Total Work RVU |
2022 |
15734 Component separation |
23.00 |
N/A |
35.65 |
49566 Open repair recurrent incisional hernia, incarcerated |
7.77† |
|||
+49568 Implantation of mesh |
4.88 |
|||
2023 |
15734 Component separation |
23.00 |
N/A |
38.12 |
49618 Repair recurrent hernia, >10 cm, incarcerated |
11.34† |
|||
+49623 Removal of total or near total non-infected mesh |
3.75 |
|||
†Multiple procedure payment reduction of 50% |
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Year |
CPT Code and Short Descriptor |
Procedure Work RVU |
Visit Work RVU |
Total Work RVU |
2022 |
49561 Open repair initial incisional hernia, incarcerated |
15.38 |
N/A |
26.22 |
49560 Open repair incisional hernia, reducible |
5.96† |
|||
+49568 Implantation of mesh |
4.88 |
|||
2023 |
49622 Repair parastomal hernia, incarcerated |
17.06 |
99231 = 1.00 |
28.69 |
49593 Repair initial hernia, 3–10 cm, reducible |
5.13† |
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†Multiple procedure payment reduction of 50% |
The ACS collaborates with KarenZupko & Associates (KZA) on courses that provide the tools necessary to increase revenue and decrease compliance risk. These courses are an opportunity to sharpen your coding skills. You also will be provided online access to the KZA alumni website, where you will find additional resources and other FAQs about correct coding. Information about the courses can be accessed at karenzupko.com/general-surgery.
In addition, as part of the College’s ongoing efforts to help members and their practices submit clean claims and receive proper reimbursement, a coding consultation service—the ACS Coding Hotline—has been established for coding and billing questions. ACS members are offered five free consultation units (CUs) per calendar year. One CU is a period of up to 10 minutes of coding services time. Access the ACS Coding Hotline website at prsnetwork.com/acshotline.
Dr. Megan McNally is a surgical oncologist at Saint Luke’s Health System in Kansas City, MO, and assistant clinical professor in the Department of Surgery at the University of Missouri-Kansas City School of Medicine. She also is a member of the ACS General Surgery Coding and Reimbursement Committee and ACS advisor to the AMA CPT Editorial Panel.
*All specific references to CPT codes and descriptions are © 2022 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.