CPT® Code 49570

Code deleted. For epigastric hernia repair, see 49591-49618.

Official Description

Repair epigastric hernia (eg, preperitoneal fat); reducible (separate procedure)

Common Language Description

An epigastric hernia repair involves the surgical correction of a specific type of hernia that occurs when abdominal contents, such as preperitoneal fat, protrude through the linea alba, which is a fibrous structure located in the midline of the abdomen. This type of hernia typically manifests in the area between the umbilicus and the xiphoid process. The procedure coded as CPT® 49570 specifically refers to the repair of a reducible epigastric hernia, meaning that the herniated contents can be pushed back into their normal anatomical position. During the surgical intervention, an incision is made directly over the hernia defect to access the hernia sac. The surgeon excises any herniated fat and inspects the contents of the sac to ensure they are healthy before returning them to the abdominal cavity. If necessary, any omentum that is adherent to the sac is also excised. The final step involves closing the opening in the fascia to restore the integrity of the abdominal wall. In some instances, a more complex repair may be required, which involves reconstructing the linea alba by approximating the anterior rectus muscles. It is important to note that if the hernia is found to be strangulated or incarcerated, a different code, CPT® 49572, should be used, as these conditions indicate a more severe situation where the hernia contents cannot be reduced or have compromised blood flow.

1. Indications

The procedure for repairing an epigastric hernia is indicated in the following situations:

Reducible Epigastric Hernia The procedure is performed when the hernia contents can be pushed back into the abdominal cavity, indicating that the hernia is reducible.
Symptomatic Hernia Patients may present with symptoms such as pain or discomfort in the epigastric region, prompting the need for surgical intervention.
Cosmetic Concerns Some patients may seek repair for cosmetic reasons, desiring to eliminate the visible bulge associated with the hernia.

2. Procedure

The surgical procedure for repairing a reducible epigastric hernia involves several key steps:

Incision An incision is made over the site of the hernia defect, allowing access to the hernia sac. This incision is typically located in the midline of the abdomen, between the umbilicus and the xiphoid process.
Excision of Herniated Fat The surgeon excises any herniated fat that is present within the hernia sac. This step is crucial for exposing the linea alba and ensuring that the hernia is adequately addressed.
Inspection of Contents The hernia sac is opened, and the contents are inspected to confirm their health. If the contents are found to be healthy, they are gently returned to the abdominal cavity.
Omental Excision If there is any omentum that is adherent to the hernia sac, it is excised to facilitate a complete repair.
Closure of Fascia The opening in the fascia is then closed to restore the structural integrity of the abdominal wall. This closure is essential to prevent recurrence of the hernia.
Complex Repair (if necessary) In rare cases where a more complex repair is required, an incision is made in each anterior rectus sheath about 1 cm from the medial edge. The rectus muscle is identified, and the incision is extended along the length of the hernia opening. The two strips of anterior rectus muscle are approximated in the midline to create a new linea alba, and the lateral cut edges of the rectus sheaths are anchored to this new structure.

3. Post-Procedure

After the epigastric hernia repair, patients are typically monitored for any immediate complications. Post-procedure care may include pain management, instructions for activity restrictions, and guidance on wound care to ensure proper healing. Patients are advised to avoid heavy lifting and strenuous activities for a specified period to prevent strain on the surgical site. Follow-up appointments are usually scheduled to assess the healing process and to address any concerns that may arise during recovery.

Short Descr	RPR EPIGASTRIC HERN REDUCE
Medium Descr	RPR EPIGASTRIC HERNIA REDUCIBLE SPX
Long Descr	Repair epigastric hernia (eg, preperitoneal fat); reducible (separate procedure)
Status Code	Active Code
Global Days	090 - Major Surgery
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62)	1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Hospital Part B services paid through a comprehensive APC
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	P5E - Ambulatory procedures - other
MUE	Not applicable/unspecified.
CCS Clinical Classification	86 - Other hernia repair