Hernia Coding Simplified in 2023

In September 2022 the American Medical Association announced the new codes for 2023. Of note for General Surgery practices was a complete overhaul for Hernia codes.

There are 15 new CPT codes (49591-49623) that will replace the existing codes which combines location, approach and specifies the size of the repair. For instance CPT code descriptions will require several things that will need documented clearly such as:

  • Repair Type: epigastric, incisional, ventral, umbilical, spigelian
  • The approach: open, laparoscopic, robotic
  • Episode: Initial or recurrent
  • Total length of defect(s) in cm
  • Outcome: Reducible, incarcerated or strangulated

Accurate documentation cannot be overstated but what remains to be seen is how reimbursement will be allocated for these code changes with so many codes being deleted and bundled into one code in 2023.

The work involved in these different techniques varies, which will require a coder to clearly understand anatomy, technique and communication with the surgeon to ensure accurate documentation as to the hernia being reducible, incarcerated or strangulated.

Now is the time to perform reviews of documentation to ensure these items are documented and that staff is educated to interpret the codes accurately. When 2023 arrives you will want to monitor the fee schedules and payments to ensure you are receiving the correct reimbursement with a change like this. Brush up on your Modifier usage and be ready for 2023.

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