2025 CPT code 49659
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Hernia Repair Surgery Feed
Unlisted laparoscopic hernia repair procedure.
Modifiers may be applicable depending on the specific circumstances of the procedure.Consult the CPT manual and payer-specific guidelines.
Medical necessity must be clearly established based on the patient's symptoms, clinical presentation, and the need for surgical repair.Documentation should support the complexity of the hernia repair and the choice of laparoscopic approach.
The surgeon performs the laparoscopic hernia repair. This includes accessing the hernia site laparoscopically, repairing the hernia defect, and potentially placing mesh reinforcement.Postoperative care is also the responsibility of the surgeon.
In simple words: This code is used when a doctor performs a minimally invasive (laparoscopic) surgery to fix a hernia, but there isn't a specific medical code for the exact procedure done.The doctor must provide detailed records explaining why a specific code couldn't be used.
This code reports laparoscopic procedures for hernia repair that do not have a specific CPT code.It encompasses hernioplasty (surgical reconstruction of a hernia), herniorrhaphy (surgical repair of a hernia), and herniotomy (incision of a hernial sac).Use of this code requires comprehensive documentation justifying the need for an unlisted code and detailed comparison to similar existing codes.
Example 1: A patient presents with a complex, recurrent incisional hernia that requires a laparoscopic repair with extensive dissection and mesh placement due to prior abdominal surgeries., A patient with a rare type of abdominal wall hernia undergoes a laparoscopic repair with a custom-designed mesh., A patient with a large ventral hernia requiring a complex laparoscopic repair with significant tissue manipulation.
* Operative report detailing the procedure performed, including specific steps, tissues involved, and mesh used (if any).* Preoperative and postoperative diagnoses.* Imaging studies (if any) showing the hernia.* Justification for using unlisted code 49659 versus other, more specific codes.A comparison to similar codes and explanation of why those codes were not appropriate is essential.
** This code should be used judiciously.Always attempt to use a specific code before resorting to 49659.Thorough documentation is critical to justify medical necessity and support reimbursement.
- Revenue Code: P5E (AMBULATORY PROCEDURES - OTHER)
- RVU: Unknown.The relative value units will vary depending on the complexity of the procedure and geographic location.Documentation supporting medical necessity is crucial for accurate reimbursement.
- Global Days: Unknown. The global period will depend on the specific procedure performed and may vary based on payer guidelines.
- Payment Status: Active
- Modifier TC rule: The application of a Technical Component (TC) modifier is dependent on the specifics of the service and the payer's policies.Additional information is needed.
- Fee Schedule: The historical fee schedule will vary by payer and geographic location.There is no specific historical fee schedule available for this unlisted code.
- Specialties:General Surgery, Hernia Surgery
- Place of Service:Ambulatory Surgical Center, Hospital Outpatient, Office