Summary & Overview
CPT 49614: Recurrent Anterior Abdominal Hernia Repair, <3 cm
CPT code 49614 covers recurrent repair of one or more anterior abdominal hernias with a combined defect length under 3 cm when the hernias are incarcerated or strangulated. The code specifies that any surgical approach may be used and that mesh or other prosthetic materials may be implanted. This procedure is clinically significant because incarcerated or strangulated hernias can lead to bowel compromise and require timely operative intervention, making accurate coding essential for clinical documentation and claims processing nationally.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for CPT code 49614, common sites and service settings for the procedure, and an outline of the typical billing landscape. The report highlights where benchmarks and policy updates are most relevant to surgical practice and code application, and it points to clinical considerations that affect coding choice and claim adjudication. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 49614 describes surgical management for recurrent repair of one or more anterior abdominal hernias when the total defect length is less than 3 cm. The procedure applies when hernias are incarcerated or strangulated, and the surgeon may use any operative approach and may implant mesh or another prosthesis as part of the repair.
Service type: Surgical — Hernia Repair (recurrent, anterior abdominal)
Typical site of service: Hospital operating room or ambulatory surgery center, depending on patient acuity and whether the hernia is incarcerated or strangulated.
Clinical & Coding Specifications
Clinical Context
A 62-year-old male presents to the emergency department with acute onset of severe lower abdominal pain, nausea, and an irreducible bulge above the pubic region. Imaging and exam confirm a recurrent incarcerated ventral/anterior abdominal wall hernia measuring approximately 2 cm in total fascial defect length with signs concerning for compromised bowel perfusion. The surgical team evaluates the patient, obtains informed consent for operative repair of a recurrent incarcerated/strangulated anterior abdominal hernia, and prepares for an urgent open or laparoscopic approach. Intraoperatively, the surgeon performs recurrent repair of one or more anterior abdominal hernia defects totaling less than 3 cm, reduces incarcerated contents, assesses viability of bowel, performs resection if necessary, and places prosthetic mesh if indicated. Typical workflow includes preoperative resuscitation and antibiotics, anesthesia evaluation (general or regional), operative repair with possible bowel resection and/or stoma creation if strangulation necessitates, perioperative documentation of defect size and recurrence status, and postoperative monitoring in the PACU with inpatient admission if complications or bowel resection occurred.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the repair requires substantially greater work than typical (extensive adhesiolysis, unexpected bowel resection). |