Summary & Overview
CPT 49621: Parastomal Hernia Repair, Reducible, Possible Mesh Implant
CPT code 49621 represents surgical repair of a parastomal hernia that is reducible and may include implantation of mesh or other prosthesis. This procedure is clinically significant because parastomal hernias can cause pain, stoma dysfunction, and risk of incarceration; repair techniques and use of prosthetic material affect surgical outcomes and resource use nationwide. The code encompasses any surgical approach, capturing a range of operative settings and techniques used by general and colorectal surgeons.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national perspective on the clinical role of this procedure, typical settings for service delivery (hospital OR and ambulatory surgery centers), and the kinds of payment and coding contexts where 49621 is applied. The publication highlights benchmarks and policy considerations relevant to surgical practice and payer coverage, summarizes common billing modifiers used with this service, and situates the code within operative and postoperative care pathways.
This summary is intended to inform coding staff, surgical providers, compliance officers, and policy analysts about the scope and application of CPT code 49621, the clinical situations where it is used, and the payer landscape that typically covers parastomal hernia repair procedures.
Billing Code Overview
CPT code 49621 describes surgical repair of a parastomal hernia using any surgical approach. The procedure is indicated when the hernia is reducible, meaning the herniated tissue can be returned to the abdominal cavity, and may include implantation of mesh or another prosthesis to reinforce the repair.
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Service type: Surgical hernia repair (open, laparoscopic, or other surgical approach)
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Typical site of service: Hospital operating room or ambulatory surgery center
Data not available in the input for specific payers, taxonomies, ICD-10 diagnoses, related codes, and service line.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a history of sigmoid colectomy and permanent colostomy presents to the general surgery clinic with a reducible bulge adjacent to the stoma that increases with Valsalva and causes discomfort with appliance fit. After clinical evaluation and imaging (abdominal CT confirming a parastomal hernia without bowel obstruction or ischemia), the surgical team schedules elective repair. In the preoperative workflow, the patient completes pre-op clearance, informed consent addresses options including primary fascial repair versus prosthetic mesh reinforcement, and bowel preparation if indicated. On the day of surgery in an outpatient ambulatory surgery center or inpatient operating room, the surgeon uses an open or laparoscopic approach to reduce the hernia sac, repair the defect, and may implant mesh to reinforce the abdominal wall around the stoma. Postoperative care includes stoma appliance refitting, wound care instructions, pain management, and follow-up visits to monitor for recurrence or complications.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default — no modifier | Use when no additional modifier applies to the service |
22 | Increased procedural services |