Hernia Repair - Hernioplasty, Herniorrhaphy, and Herniotomy

 Hernia Repair - Hernioplasty, Herniorrhaphy, and Herniotomy

Techniques:

The technique selected by the surgeon to repair the hernia is based on the type of hernia and its appropriateness for the patient.

The Conventional Method (eg, herniorrhaphy)

An incision is made over the site of the hernia. The protruding tissue is returned to the abdominal cavity, and the protruding sac is removed if necessary. The defect or weakness in the abdominal wall is repaired in layered closure over the defect. This is the most common method of hernia repair.

Tension-Free Mesh Technique (eg, hernioplasty)

An incision is made at the hernia site, and a piece of biologic or synthetic mesh is inserted and secured to cover the area of the abdominal wall defect with or without sewing together the surrounding muscles.

The Laparoscopic Method (eg, herniorrhaphy)

The laparoscopic method of repair is performed by placing a videolaparoscopic camera and laparoscopic instruments through trocars (instrument holders), which allow the surgeon to repair the defect in the abdominal wall using biologic or synthetic mesh, under a general anesthesia.

Codes in the 49491-49611 series (with the exception of code 49568) are used to report conventional open surgical hernia repair procedures; code 49568 is the add-on code reported separately for the implantation of mesh only with the incisional or ventral hernia repair codes (codes 49560-49566); codes 49650 and 49651 report various laparoscopic hernia repairs; and code 49659 is used to report unlisted laparoscopy procedures for hernioplasty, herniorrhaphy, or herniotomy.

Types of Hernias:

Hernia repair codes and the appropriate treatment are categorized primarily by the type of hernia.

Inguinal hernia (codes 49491-49525, 49650, and 49651)

Inguinal hernia occurs in the area between the abdomen and thigh. Some intra-abdominal organs may partially push through a weak spot in the inguinal canal.

Lumbar hernia (code 49540)

Lumbar hernia, which is rare, results from a protrusion between the last rib and the iliac crest.

Femoral hernia (codes 49550-49557)

Femoral hernia occurs through the femoral ring.

Incisional or ventral hernia (codes 49560-49566 and 49568)

Incisional or ventral hernias may occur either spontaneously or in the area of a prior abdominal incision. The latter develops as the result of a thinning, separation, or tear in the fascial closure from prior surgery or other causes of separation and weakness unrelated to prior surgery.

Epigastric hernia (codes 49570-49572)

Epigastric hernia occurs through the linea alba above the umbilicus.

Umbilical hernia (codes 49580-49587)

Umbilical hernia is a protrusion of intestine and/or omentum through a hernia in the abdominal wall near the navel. This type of hernia normally corrects itself after birth. When the hernia doesn't correct itself, surgical repair may be necessary.

Spigelian hernia (code 49590)

Spigelian hernia is a rare lateral ventral hernia.

Omphalocele/Gastroschisis (codes 49600-49611)

Omphalocele is congenital outpouching of intra-abdominal organs through the area of the umbilicus in the fetus or newborn. An omphalocele is generally covered by a membrane. Gastroschisis is a congenital disorder manifested by the extrusion of intestines through an abdominal wall defect lateral to the umbilicus in the fetus or newborn. Gastroschisis is usually not covered by a membrane.

Hernia Characteristics:

•  Incarcerated: A hernia in which the affected intestine is trapped or twisted within the hernia sac

•  Indirect: An inguinal hernia that is the result of the failure of embryonic closure of the internal inguinal ring

•  Initial: No previous hernia repair has been required

•  Nonreducible hernia: The hernia contents are fixed in the hernia sac and cannot be reduced

by manipulation

•  Recurrent: Previous hernia repair has been performed

•  Reducible: The hernia contents move freely and the hernia can be reduced by manual manipulation

•  Strangulated: Strangulation at the hernia ring obstructs the blood supply to the herniated part (abdominal content [eg, bowel or omentum])

 

 

Coding Tips:

•     The initial treatment of a hernia can be by manual reduction. This is a temporary measure used to alleviate the problems associated with the hernia. This reduction is performed as part of an evaluation and management (E/M) service and is not reported separately. When a manual reduction is the only service performed, unlisted code 49999 may be reported to indicate the service provided.

•     Repair of diaphragmatic or hiatal hernia is not reported with the codes in the hernia repair section. Codes 39502-39541 from the Mediastinum and Diaphragm subsection of Surgery are used to report this type of hernia repair.

•     When a code descriptor indicates "repair recurrent inguinal hernia, any age, reducible," this means that the hernia has been previously surgically put back into its normal body cavity and that the hernia has been surgically repaired. If a hernia is manually reduced and not surgically repaired, the reprotrusion of the hernial contents does not constitute a recurrence.

•     Hernia repair codes report the repair of the hernia only. Any excision or repair of strangulated organs or structures, if performed, would be reported with a separate code(s) in addition to the code for the hernia repair. The additional procedure(s) is identified by appending modifier 51, Multiple Procedures, to the secondary procedure(s) reported.

•     The descriptor for codes 49491-49501 indicates "with or without hydrocelectomy." These codes include the hydrocelectomy, and a separate code is not reported with codes 49491-49501. However, when a hydrocelectomy is performed with a hernia repair described by codes 49505-49507, it would be reported using code 55040 for the excision of the hydrocele in addition to the appropriate hernia repair code.