Revised Surgical Hernia CPT Codes

In 2023, ASA published a Timely Topic on hernia billing which was not as clear as hoped. This revised algorithm may be more helpful in working with the 2023 additions and deletions to the surgical CPT codes and descriptions shown in Table 1. The new decision tree at the bottom (Figure 1) may reinforce the bottom line of many anesthesia practices by helping to ensure proper payment for our services through a systematic approach.

1. Upper vs. Lower Abdomen
   As before, the first step in the process is determining the location of the hernia repair relative to the umbilicus (Figure 1). If the hernia is above the umbilicus, it is considered upper abdominal, and anesthesia CPT codes 00750, 00752, or 00790 are appropriate. If it is below the umbilicus, it is considered lower abdominal, and anesthesia codes 00830, 00832, 00834, 00836, or 00840 are appropriate.
2. Hernia Descriptor: Extra-peritoneal vs. Intra-peritoneal
   In keeping with increased anesthesia work intensity from intraperitoneal procedures, the next step is the hernia’s relationship to the peritoneum. An intraperitoneal approach for the hernia repair may or may not be necessary, but incarcerated or strangulated hernias are intraperitoneal by definition to assure there is no residual bowel ischemia or infarction. A laparoscopic approach is similarly intraperitoneal and thereby higher work intensity. When the hernia repair is extraperiotoneal (outside the peritoneum even if includes the peritoneum itself), the work intensity is expected to be lower.
3. Hernia Descriptor: Hernia Type
   Although the surgical descriptors no longer include epigastric, incisional, ventral, and Spigelian, the new surgical codes allow for the increased challenges associated with hernia repairs in unusual locations (e.g. lumbar triangle hernias), incisional hernias (where there may be scar tissue), or dehiscence. These conditions and others can increase the requirements and intensity of the required anesthetic management compared to simple hernias and are captured with the extra-peritoneal repair code of 00752 for upper abdominal and 00832 for lower abdominal hernias. This descriptor may require the biller/coders to review the operative note to determine whether the repair is in the extraperitoneal space exclusively.
4. Age
   Special consideration for patient age at the time of repair is made due to the added complexity and anesthesia work intensity. In lower abdominal hernia repairs on children under one year of age, the anesthesia CPT code used is 00834. Further, if the patient has a lower abdominal hernia repair AND is born prematurely at less than 37 weeks of gestation and is less than 50 weeks of gestational age at the time of surgery, the anesthesia CPT code is 00836. Existing anesthesia codes for the complex upper abdominal wall defects of omphalocele and gastroschisis are separate from the hernia codes.

Some examples are listed in Table 2 for demonstration.

Please contact CROSSWALK@asahq.org if you have further questions.

Table 1: Summary of Anesthesia for Hernia Repair CPT Codes

Figure 1: Decision Tree

*Anesthesia for hernia repairs in the lower abdomen not otherwise specified; younger than 1 year of age   00834

Anesthesia for hernia repairs in the lower abdomen not otherwise specified; infants younger that 37 weeks gestation age at birth and younger than 50 weeks gestational age at time of surgery    00836

Table 2. Examples of Anesthesia Billing Based on New Hernia CPT Code Descriptions