Hernia and Abdominal Wall Coding

Abstract

For the purpose of CPT coding and reimbursement, hernia repairs are classified as inguinal or ventral, with a few other unusual hernia types. Each has its own subsection in CPT. There are separate codes for open and laparoscopic repairs. Some hernia repairs are further classified by age of the patient (premature infant, child, or adult), reducibility of the hernia (reducible or incarcerated/strangulated), and the recurrent nature of the defect (initial or recurrent hernia). Complex abdominal wall hernia repairs are described with a combination of codes, including a code for myofascial advancement flap when separation of components is performed. Most hernia repairs are valued to include placement of prosthetic mesh; however, open ventral hernia repair is not, and an add-on code is needed to code for mesh placement. Although hernia repair codes are fairly granular—that is, there are many descriptors to describe the procedure—not every technique has its own specific code, and newer techniques remain investigational by CPT criteria.