2025 CPT code 49614
(Active) Effective Date: N/A Revision Date: N/A Surgery - Hernioplasty, Herniorrhaphy, Herniotomy Procedures Surgical Procedures on the Digestive System Feed
Recurrent repair of one or more incarcerated or strangulated anterior abdominal hernias (less than 3 cm total defect length).
Modifiers such as 50 (bilateral procedure), 51 (multiple procedures), and others may apply depending on the specific clinical scenario.Consult the CPT manual for details.
Medical necessity is established when the patient has a recurrent, symptomatic anterior abdominal hernia causing pain, bowel obstruction, or strangulation.The repair is considered medically necessary to alleviate these symptoms and prevent complications.
The surgeon's responsibility involves pre-operative assessment, surgical repair of the hernia(s) including dissection, reduction of incarcerated or strangulated bowel, placement of mesh or other prosthesis (if applicable), and post-operative care.
- Surgical Procedures on the Digestive System
- Surgical Procedures on the Digestive System > Surgical Procedures on the Abdomen, Peritoneum, and Omentum > Repair Procedures on the Abdomen, Peritoneum, and Omentum > Hernioplasty, Herniorrhaphy, Herniotomy Procedures > Hernia Open Procedures
In simple words: This code covers a surgeon's work to fix a recurring hernia in the abdomen. The hernia is trapped (incarcerated) or has its blood supply cut off (strangulated). The surgeon may use mesh or other material during the repair. The total size of the hernias is small (less than 3 cm).
This CPT code encompasses the recurrent repair of one or more incarcerated or strangulated anterior abdominal hernias using any approach (open, laparoscopic, or robotic).The total length of all defects, measured before opening, is less than 3 cm. Mesh or other prosthesis implantation may be included but is not required for code assignment. The repair includes dissection, removal of adhesions, reduction of incarcerated/strangulated tissue, and closure of the defect(s).
Example 1: A 65-year-old female patient presents with a recurrent incarcerated incisional hernia following a previous abdominal surgery. The hernia is less than 3 cm and requires surgical repair with mesh placement., A 50-year-old male patient has a recurrent strangulated epigastric hernia measuring less than 3 cm. The hernia is repaired laparoscopically without mesh., A 70-year-old patient presents with two recurrent, small (total less than 3cm) strangulated ventral hernias that are repaired via an open approach. Mesh is placed to reinforce the abdominal wall.
Complete medical history, physical examination findings, operative report detailing the approach, size of the defect(s), type of hernia, presence of incarceration or strangulation, use of mesh or other prosthesis, and post-operative course.Imaging studies (ultrasound, CT scan) may be necessary.
** Accurate documentation is paramount for proper reimbursement.Any discrepancies in documentation may lead to claim denial.Consult with a coding specialist if there are any ambiguities.
- Revenue Code: P5E (AMBULATORY PROCEDURES - OTHER)
- RVU: Refer to the Medicare Physician Fee Schedule (MPFS) for current RVU values.RVUs will vary based on facility vs. non-facility settings and may change annually.
- Global Days : This code is not associated with a global surgical period.Payment is for the procedure only.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier may not apply to this code as it represents the entire procedure.
- Fee Schedule : Historical fee schedule data can be found in publicly available resources like the Medicare Physician Fee Schedule (MPFS) archives.Note that historical data should not be used for current billing.
- Specialties:General Surgery, Gastroenterology
- Place of Service:Office, Ambulatory Surgical Center, Inpatient Hospital