Summary & Overview
HCPCS C7565: Recurrent Anterior Abdominal Hernia Repair with Mesh Removal
HCPCS Level II code C7565 denotes surgical repair of recurrent anterior abdominal hernias (epigastric, incisional, ventral, umbilical, spigelian) with defect(s) under 3 cm, including removal of total or near-total non-infected mesh and implantation of mesh or prosthesis when performed. This code specifies repair by any approach (open, laparoscopic, robotic) and is intended for reducible, recurrent hernias. Nationally, accurate use of this code affects surgical quality measurement, claims processing, and aggregation of utilization for ventral and incisional hernia management.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical scope of the code, typical sites of service, and common billing contexts. The publication highlights benchmarks and coding guidance relevant to recurrent anterior abdominal hernia repairs with mesh removal, clarifies when C7565 is applicable, and outlines areas where policy updates or payer-specific edits commonly arise.
This overview provides clinicians, coders, and administrators with the clinical context and billing parameters tied to C7565, enabling consistent code selection and clearer communication with payers about recurrent hernia procedures that include prosthesis removal or implantation.
Billing Code Overview
HCPCS Level II code C7565 describes repair of anterior abdominal hernia(s) (for example, epigastric, incisional, ventral, umbilical, spigelian), any approach (open, laparoscopic, or robotic), for a recurrent hernia. The procedure includes implantation of mesh or other prosthesis when performed, with total length of defect(s) less than 3 cm, and is limited to reducible hernias with removal of total or near-total non-infected mesh or other prosthesis at the time of initial or recurrent anterior abdominal hernia repair or parastomal hernia repair.
Service type: Surgical procedure — anterior abdominal hernia repair, recurrent, with removal of non-infected mesh when performed.
Typical site of service: Hospital inpatient or outpatient surgical center; ambulatory surgical setting.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a history of a prior open ventral hernia repair presents with a recurrent, reducible midline ventral hernia defect measuring 2.5 cm. The patient complains of intermittent localized pain and a palpable bulge that increases with Valsalva. Preoperative evaluation includes history and physical, focused abdominal exam, basic labs, and cross-sectional imaging (CT abdomen/pelvis) to evaluate defect size and prior mesh position. The surgical plan is a repeat anterior abdominal wall hernia repair (recurrent ventral/epigastric/incisional/umbilical type) via an appropriate approach (open, laparoscopic, or robotic) with removal of total or near-total non-infected prior mesh and implantation of new mesh as needed. Intraoperatively the defect measures less than 3 cm, is reducible, and the prior mesh is non-infected and removed. Postoperative workflow includes routine recovery monitoring in the ambulatory surgery unit or inpatient PACU depending on anesthesia and comorbidities, pain management, wound care instructions, and follow-up visits at 1–2 weeks and at 3 months to assess wound healing and recurrence. Typical documentation includes operative report detailing approach, mesh removal, defect size (<3 cm), recurrence status, implant use, and any intraoperative complications. Billing uses HCPCS Level II code C7565 to represent this specific recurrent anterior abdominal hernia repair scenario when payer policies recognize the HCPCS code for the service.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |