General Surgery Coding Alert

Question: When a patient undergoes a laparoscopic ventral incisional hernia repair, would the coder use the 49552-49553 (ventral) or 49654-49657 (incisional) codes? Coders were not faced with this decision previously because incisional and ventral were under the same open codes.

Florida Subscriber

Answer: You should use the appropriate incisional hernia repair code (49654-49655, Laparoscopy,surgical, repair, incisional hernia [includes mesh insertion, when performed] ... ; or 49656-49657,Laparoscopy, surgical, repair, recurrent incisional hernia [includes mesh insertion, when performed] ...).

Here's why: The incisional hernia repair codes include the reimbursement and work associated with an incisional defect with expected adhesions, scarring, and other extra work associated with a procedure related toa previous surgical site.

You would rarely use the new ventral hernia repair codes (49552-49553, Laparoscopy, surgical, repair, ventral, umbilical, spigelian, or epigastric hernia [includes mesh insertion, when performed] ...)  primarily to describe traumatic hernias -- that is why CPT groups these codes with other hernias that are not related to previous surgery.