2025 CPT code 49596
(Active) Effective Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Repair of anterior abdominal hernia(s) (i.e., epigastric, incisional, ventral, umbilical, spigelian), any approach (i.e., open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); greater than 10 cm, incarcerated or strangulated.
Medical necessity must be established for hernia repair based on the patient's symptoms, the risk of complications (e.g., strangulation), and the impact on their quality of life.
The surgeon prepares the patient and performs the hernia repair using the chosen approach. This includes identifying the hernia sac(s), reducing the incarcerated/strangulated tissue back into its proper position, and closing the defect(s), often with mesh reinforcement.The total defect length is measured before the hernia is opened.
In simple words: The surgeon repairs a large hernia (or multiple hernias) in the abdominal area.The hernia(s) are trapped or have their blood supply cut off, requiring immediate surgery. The surgeon can use any surgical method. This is the first time this hernia has been repaired. The procedure may include placing a mesh to strengthen the abdominal wall.
The provider uses any approach (open, laparoscopic, or robotic) to perform an initial repair of one or more anterior abdominal hernias (epigastric, incisional, ventral, umbilical, or spigelian). The total length of all defects is greater than 10 cm, and the hernias are incarcerated or strangulated. Implantation of mesh or other prosthesis is included when performed.
Example 1: A patient presents with an incarcerated umbilical hernia greater than 10 cm in length. The surgeon performs an open repair with mesh implantation using code 49596., A patient has two incisional hernias, one 6 cm and the other 5 cm, totaling 11 cm, both strangulated. The surgeon performs a laparoscopic repair with mesh, using code 49596., A patient with a recurrent ventral hernia develops an incarcerated spigelian hernia. During the same surgical session, the surgeon repairs both hernias using a robotic approach. The combined defect length is greater than 10 cm. Code 49596 is used for the incarcerated spigelian hernia, and a separate code is used for the recurrent ventral hernia repair.
Documentation should include the type and location of each hernia, the approach used (open, laparoscopic, robotic), the size of each defect (measured before opening), the status of each hernia (reducible, incarcerated, strangulated), whether mesh was used, and any complications.
- Specialties:General Surgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center