CPT 49618: Recurrent Anterior Abdominal Hernia Repair, Incarcerated/Strangulated - OpenPayer

Summary & Overview

CPT 49618: Recurrent Anterior Abdominal Hernia Repair, Incarcerated/Strangulated

CPT code 49618 represents surgical repair of recurrent anterior abdominal hernias longer than 10 cm that are incarcerated or strangulated, with allowance for any surgical approach and optional implantation of prosthetic mesh. This code is clinically significant because it captures complex hernia repairs with higher resource use and potential perioperative risk, which affect hospital surgical scheduling, resource allocation, and payer reimbursement pathways nationally. Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for CPT code 49618, typical sites of service, and the service type. The publication provides benchmark considerations for payers listed above, outlines common billing modifiers associated with complex surgical procedures (provided in the input), and summarizes relevant policy and coverage themes that commonly apply to complex hernia repairs. Clinical context covers indications implied by the code — recurrent, incarcerated, or strangulated anterior abdominal hernias exceeding 10 cm — and implications for operative approach and use of prosthetic materials. When specific data elements were not available in the input, the content indicates that information is not provided rather than inferred.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 49618hernia repairanterior abdominal herniasurgical proceduremesh implantationrecurrent herniaincarcerated herniastrangulated herniaoperating room

Billing Code Overview

CPT code 49618 describes recurrent repair of one or more anterior abdominal hernias with a total length greater than 10 cm for hernias that are incarcerated or strangulated. The procedure may be performed using any surgical approach and may include implantation of mesh or another prosthesis.

Service type: Surgical repair of recurrent, complicated anterior abdominal hernia(s)
Typical site of service: Hospital operating room or ambulatory surgical center for operative management of incarcerated or strangulated hernias

Clinical & Coding Specifications

Clinical Context

A 62-year-old male with a history of prior open ventral hernia repair presents to the emergency department with severe abdominal pain, a tender midline bulge and vomiting. Imaging and exam suggest a recurrent, incarcerated midline anterior abdominal wall hernia with signs concerning for compromised bowel. The surgical team evaluates the patient, obtains informed consent for urgent operative repair, and prepares for general anesthesia. Intraoperatively the surgeon performs a recurrent repair of one or more anterior abdominal hernias with a combined defect length greater than 10 cm; the herniated bowel is assessed for viability, viable bowel is reduced, and prosthetic mesh is implanted to reinforce the repair. The procedure may occur in an inpatient operating room setting for urgent/emergent care; preoperative documentation includes history, focused exam, consent, anesthesia record, and operative note describing approach, defect measurements, bowel status (incarcerated or strangulated), mesh type and fixation, and any intraoperative complications. Typical perioperative workflow includes antibiotic prophylaxis, venous thromboembolism prophylaxis, postoperative monitoring for return of bowel function, pain control, and wound checks during the inpatient stay or same-day observation if clinically appropriate.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than usual for this code (extensive adhesiolysis, bowel resection).

CPT 49605: Repair of Large Omphalocele or Gastroschisis

cpt-49521-recurrent-incarcerated-strangulated-inguinal-hernia-repair

CPT 49521: Recurrent Incarcerated or Strangulated Inguinal Hernia Repair

cpt-49496-infant-inguinal-hernia-repair-with-hydrocele-excision

CPT 49496: Infant Inguinal Hernia Repair with Hydrocele Excision

cpt-49621-parastomal-hernia-repair-reducible-mesh-implant

CPT 49621: Parastomal Hernia Repair, Reducible, Possible Mesh Implant

49505

CPT 49505: Surgical Repair of Initial Reducible Inguinal Hernia, Age 5+ Years

cpt-49596-repair-large-incarcerated-strangulated-anterior-abdominal-hernia

CPT 49596: Repair of Large Incarcerated or Strangulated Anterior Abdominal Hernia

cpt-49557-recurrent-femoral-hernia-repair-incarcerated-strangulated

CPT 49557: Recurrent Femoral Hernia Repair, Incarcerated or Strangulated

cpt-49492-premature-infant-incarcerated-inguinal-hernia-repair

CPT 49492: Repair of Incarcerated Inguinal Hernia in Premature Infant

cpt-49606-omphalocele-gastroschisis-repair-prosthesis-removal

CPT 49606: Repair of Large Omphalocele or Gastroschisis, Prosthesis Removal

cpt-49610-omphalocele-repair-first-stage-gross-type

CPT 49610: Omphalocele Repair, First-Stage Gross-Type

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Taxonomy Code	Specialty	Notes
207P00000X	General Surgery	Most common specialty performing open anterior abdominal wall hernia repairs.
207RT0001X	Colon and Rectal Surgery	May manage complex abdominal wall defects involving bowel resection or colorectal pathology.
207L00000X	Thoracic Surgery	Occasionally involved when hernias extend to subxiphoid or lower thoracic areas.
2080S0128X	Acute Care Surgery	Manages emergent incarcerated or strangulated hernias in trauma/acute settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K43.2`	Incisional hernia with obstruction, without gangrene	Recurrent incisional/ventral hernia causing bowel obstruction; commonly presents with incarceration requiring repair.
`K43.3`	Incisional hernia with gangrene	Hernia with strangulation and bowel ischemia; may necessitate resection during repair.
`K41.2`	Recurrent inguinal hernia, unilateral, incarcerated	While inguinal specific, incarcerated recurrent hernias illustrate emergent presentation similar to anterior abdominal wall recurrence.
`K42.2`	Recurrent ventral hernia, incarcerated	Describes recurrent ventral/anterior hernia with incarceration consistent with indication for `49618`.
`K46.2`	Unspecified abdominal hernia, recurrent, with obstruction	Recurrent abdominal wall hernia producing obstruction; supports emergent operative intervention.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`49650`	Laparoscopic repair, incarcerated or strangulated ventral or incisional hernia, with or without mesh	Alternative laparoscopic approach for incarcerated/strangulated anterior hernias; may be chosen instead of open repair depending on surgeon judgment.
`49560`	Repair, incarcerated or strangulated femoral hernia; initial, any age	Related emergent hernia repair code for femoral location when the incarcerated/strangulated hernia is femoral rather than anterior abdominal.
`49561`	Repair, incarcerated or strangulated femoral hernia; recurrent	Recurrent femoral hernia repair analogous to recurrent anterior hernia setting when recurrence occurs.
`49568`	Repair, initial incisional or ventral hernia; reducible	Elective repair code for ventral/incisional hernias that are reducible and may be performed in non-emergent settings.
`44120`	Enterectomy, resection of small intestine; single resection and anastomosis	Performed when strangulation leads to nonviable bowel requiring resection during hernia repair.
`49905`	Unlisted procedure, abdomen, peritoneum and omentum	Used when a component of the operative procedure is not described by existing codes and needs separate billing description.

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