Repair initial incisional or ventral hernia; reducible
Relative Value Units (RVUs)
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Clinical Information
When to Use
For open repair of reducible incisional or ventral hernia
Common Scenarios
Documentation Requirements
- Location and size of hernia defect
- History of previous surgery
- Surgical approach and technique
- Mesh placement and type
- Fascial closure method
Coding Guidelines
Common Modifiers
Bundling Rules
- Includes hernia sac dissection
- Includes mesh placement
- Includes fascial repair
- Adhesiolysis bundled when performed same session
- Wound closure bundled when performed same session
Exclusions
- 49561 (incarcerated incisional hernia)
- 49652 (laparoscopic ventral hernia repair)
- 49568 (recurrent incisional hernia)
Coding Notes
Clinical scenarios
- Location and size of hernia defect
- History of previous surgery
- Surgical approach and technique
- Location and size of hernia defect
- History of previous surgery
- Surgical approach and technique
- Location and size of hernia defect
- History of previous surgery
- Surgical approach and technique
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Code Details
Medicare Pricing
Pricing data not available for this code.
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Ask a QuestionFrequently Asked Questions
CPT 49560 is the billing code for "Repair initial incisional or ventral hernia; reducible". For open repair of reducible incisional or ventral hernia
CPT 49560 has a total RVU of 22.50, broken down as: Work RVU 10.00, Practice Expense RVU 11.50, and Malpractice RVU 1.00. RVUs (Relative Value Units) determine Medicare reimbursement rates.
Key documentation requirements for CPT 49560 include: Location and size of hernia defect; History of previous surgery; Surgical approach and technique; Mesh placement and type. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 49560: Includes hernia sac dissection. Includes mesh placement Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 49560 include: 22 (Increased procedural services for complex repair), 51 (Multiple procedures performed same session), 52 (Reduced services if procedure not completed). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 49560 is 60-90 minutes typical operative time. Time-based codes require documentation of the actual time spent providing the service.