2025 CPT code 49613
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Hernia Repair Surgery Feed
Recurrent anterior abdominal hernia repair (reducible), total defect length <3cm, any approach.
Modifiers may be applicable depending on the circumstances of the procedure (e.g., 51 for multiple procedures, 59 for distinct procedural services, 78 for unplanned return to the OR).
Medical necessity for recurrent hernia repair is established by the presence of symptoms (pain, discomfort, bulging), and the potential for complications (incarceration, strangulation). Documentation should support the clinical indication for repair.
The surgeon's responsibilities include pre-operative assessment, surgical repair of the hernia (including mesh placement if indicated), and post-operative care.This may involve anesthesia, incision, hernia sac reduction, tissue repair, and wound closure.
In simple words: This code covers fixing a hernia that has come back after a previous surgery. The hernia is in the front of your abdomen and can be pushed back in. The doctor can use different methods (open surgery, small incisions, or robots) to repair it, possibly using a mesh to support the area.
This CPT code describes the recurrent repair of one or more reducible anterior abdominal hernias (epigastric, incisional, ventral, umbilical, or spigelian) using any approach (open, laparoscopic, or robotic).The total distance between the outer margins of all defects, measured before opening, is less than 3 cm. Mesh or other prosthesis implantation may be included but is not required.
Example 1: A 60-year-old female patient presents with a recurrent reducible incisional hernia, measuring 2cm in diameter, following prior abdominal surgery.The surgeon performs a laparoscopic repair using mesh., A 45-year-old male patient presents with a recurrent reducible umbilical hernia, measuring 2.5cm, following previous unsuccessful umbilical hernia repair. The surgeon performs an open repair with suture closure., A 72-year-old male patient presents with two small, recurrent reducible epigastric hernias, each measuring less than 1cm in diameter. The total length of both defects is less than 3cm.The surgeon performs a robotic-assisted repair with mesh.
Preoperative assessment documenting the hernia location, size, reducibility, and prior repair attempts. Operative report detailing the surgical approach (open, laparoscopic, robotic), mesh use (type and size), and defect size measurements.Post-operative progress notes documenting the patient's recovery.
** Accurate measurement of the total length of the defect(s) is crucial for proper code assignment.Consult with a coding specialist if unsure about the correct code selection for a specific clinical scenario.
- Revenue Code: P5E (Ambulatory Procedures - Other)
- RVU: Refer to the CMS national physician fee schedule for current RVU values.RVUs will vary based on the geographical location, facility type, and other factors.
- Global Days: The global period will vary depending on payer and local practice guidelines. Consult payer-specific guidelines for clarification.
- Payment Status: Active
- Modifier TC rule: TC modifiers might be applicable depending on payer and local practice guidelines.
- Fee Schedule: Refer to CMS historical fee schedules for previous RVU values and payment rates.
- Specialties:General Surgery, Gastroenterology
- Place of Service:Office, Ambulatory Surgical Center, Hospital (Inpatient or Outpatient)