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49652

Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia; reducible

Surgery Minimally Invasive Surgery 25.32 Total RVUs
Quick Reference
For laparoscopic repair of reducible ventral, umbilical, spigelian, or epigastric hernia

Relative Value Units (RVUs)

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Work RVU
11.20
Physician effort
PE RVU
13.00
Practice expense
MP RVU
1.12
Malpractice
Total RVU
25.32
Combined value
Dollar reimbursement rates vary by locality and payer. RVUs shown for relative comparison only.
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Clinical Information

When to Use

For laparoscopic repair of reducible ventral, umbilical, spigelian, or epigastric hernia

Time Requirement
60-90 minutes typical operative time

Common Scenarios

Laparoscopic ventral hernia repair
Laparoscopic umbilical hernia repair
Laparoscopic spigelian hernia repair
Laparoscopic epigastric hernia repair
Minimally invasive abdominal wall hernia repair

Documentation Requirements

  • Indication for laparoscopic hernia repair
  • Hernia type and location
  • Laparoscopic approach used
  • Mesh placement documented
  • Any complications

Coding Guidelines

Common Modifiers

51 Multiple procedures performed same session
22 Increased procedural services for difficult cases
59 Distinct procedural service if performed separately

Bundling Rules

  • Includes laparoscopic hernia repair
  • Includes mesh placement
  • Diagnostic laparoscopy bundled
  • Multiple hernias repaired bundled
  • Conversion to open coded separately

Exclusions

  • 49560 (open ventral hernia repair)
  • 49585 (open umbilical hernia repair)
  • 49650 (laparoscopic inguinal hernia repair)
  • 49651 (laparoscopic recurrent inguinal hernia repair)

Coding Notes

Laparoscopic approach
Includes ventral, umbilical, spigelian, or epigastric
Mesh placement included
Global period is 90 days

Clinical scenarios

Laparoscopic ventral hernia repair
Laparoscopic ventral hernia repair
When to use:For laparoscopic repair of reducible ventral, umbilical, spigelian, or epigastric hernia
  • Indication for laparoscopic hernia repair
  • Hernia type and location
  • Laparoscopic approach used
Laparoscopic umbilical hernia repair
Laparoscopic umbilical hernia repair
When to use:For laparoscopic repair of reducible ventral, umbilical, spigelian, or epigastric hernia
  • Indication for laparoscopic hernia repair
  • Hernia type and location
  • Laparoscopic approach used
Laparoscopic spigelian hernia repair
Laparoscopic spigelian hernia repair
When to use:For laparoscopic repair of reducible ventral, umbilical, spigelian, or epigastric hernia
  • Indication for laparoscopic hernia repair
  • Hernia type and location
  • Laparoscopic approach used

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Code Details

Code 49652
Category Surgery
Subcategory Minimally Invasive Surgery
Total RVUs 25.32

Medicare Pricing

Pricing data not available for this code.

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Frequently Asked Questions

What is CPT code 49652?

CPT 49652 is the billing code for "Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia; reducible". For laparoscopic repair of reducible ventral, umbilical, spigelian, or epigastric hernia

What are the RVUs for CPT 49652?

CPT 49652 has a total RVU of 25.32, broken down as: Work RVU 11.20, Practice Expense RVU 13.00, and Malpractice RVU 1.12. RVUs (Relative Value Units) determine Medicare reimbursement rates.

What documentation is required for CPT 49652?

Key documentation requirements for CPT 49652 include: Indication for laparoscopic hernia repair; Hernia type and location; Laparoscopic approach used; Mesh placement documented. Missing or incomplete documentation is a leading cause of claim denials for this code.

Can CPT 49652 be billed with other codes?

Bundling considerations for CPT 49652: Includes laparoscopic hernia repair. Includes mesh placement Use an NCCI bundling checker to verify specific code combinations before billing.

What modifiers are commonly used with CPT 49652?

Common modifiers for CPT 49652 include: 51 (Multiple procedures performed same session), 22 (Increased procedural services for difficult cases), 59 (Distinct procedural service if performed separately). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

What is the time requirement for CPT 49652?

The typical time requirement for CPT 49652 is 60-90 minutes typical operative time. Time-based codes require documentation of the actual time spent providing the service.

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