What ASCs Need to Know About the 2023 CPT Code Revisions

asc May 4, 2023

Ambulatory Surgery Centers (ASCs) specialize in providing patients with outpatient surgical procedures that do not require hospitalization. As an ASC provider, you strive to deliver high-quality care in a convenient, comfortable setting while offering a cost-effective alternative to traditional hospital surgery. 

Moreover, ASCs can perform different surgeries, including orthopedic surgery, eye surgery, urology, gynecology, and plastic surgery. But the most common condition that is treated at ASCs is hernias. It occurs when an organ protrudes through a tear or weak spot in the surrounding muscles or connective tissues. An inguinal hernia is the most common type of abdominal wall hernia.

Most importantly, you must match the above conditions with appropriate codes, such as the Current Procedural Terminology (CPT®) coding system. Ambulatory surgery centers (ASCs) depend heavily on the Current Procedural Terminology (CPT®) coding system to track and bill the correct procedures for the right patients.

This blog will discuss what you need to know about the changes to ambulatory surgery center CPT codes.

The Key Changes in the 2023 CPT Code Revision for ASCs

It’s time to hit the ground running, as the list of 2023 CPT codes for ambulatory surgery centers is here. Here are some of the most significant changes ASCs need to know.

Hernia CPT Codes 2023

Among the most significant changes is the hernia CPT codes. There were 18 deleted CPT codes for 2023, which were replaced by 12 new ones

CPT® revised hernia repair codes and concepts. These are significant changes to commonly used surgical procedures. Meanwhile, the AMA has introduced a new language in the repair codes: “This section categorizes hernia repair codes based on the type of hernia (inguinal, femoral, lumbar, omphalocele, anterior abdominal, parastomal.) Depending on whether the hernia has required a previous repair, they are classified as either initial or recurrent. Several codes are further defined based on the patient’s age and whether the hernia is reducible or incarcerated or strangulated.”

Whenever you repair an anterior abdominal hernia, you’ll report one of the 12 new codes from the table below. The CPT® 2023 classifies these 12 new codes according to initial or recurrent, reducible or incarcerated/strangulated, and repair size:

2023 CPT CodeDescription
49591 Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); less than 3 cm, reducible
49592Less than 3 cm, incarcerated or strangulated
495933 cm to 10 cm, reducible
495943 cm to 10 cm, incarcerated or strangulated 
49595Greater than 10 cm, reducible
49596Greater than 10 cm, incarcerated or strangulated
Recurrent Codes
49613Repair of anterior abdominal hernia(s) (ie, epigastric, incisional, ventral, umbilical, spigelian), any approach (ie, open, laparoscopic, robotic), recurrent, including implantation of mesh or other prosthesis when performed, total length of defect(s); less than 3 cm, reducible
49614Less than 3 cm, incarcerated or strangulated
496153 cm to 10 cm, reducible
496163 cm to 10 cm, incarcerated or strangulated
49617Greater than 10 cm, reducible
49618Greater than 10 cm, incarcerated or strangulated
49621Repair of parastomal hernia, any approach (i.e., open, laparoscopic, robotic), initial or recurrent, including placement of mesh or other prosthesis, when performed; reducible
49622Incarcerated or strangulated
49623Removal 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, any approach (i.e., open, laparoscopic, robotic) (List separately in addition to code for primary procedure) (Use 49X15 in conjunction with 49X01–49X14)

The CPT codes for laparoscopic inguinal hernia repair have only two codes: 

  • 49650 (Laparoscopy, surgical; repair initial inguinal hernia) 
  • 49651 (Repair recurrent inguinal hernia)

The new CPT code changes for 2023 will significantly impact the billing practices of ASCs, and as a provider, you need to stay up-to-date and adapt accordingly.

Deleted CPT Codes for 2023

In CPT® 2023, 18 hernia repair codes have been deleted. For open hernia repair, you will no longer need to report the following codes:

  • 49560-49566 (Incisional or ventral hernia CPT codes)
  • 49570-49572 (Epigastric hernia repair CPT codes)
  • 49580-49587 (Umbilical hernia repair CPT codes)
  • 49590 (Spigelian hernia CPT codes)

Similarly, you will not use the following laparoscopic hernia codes in 2023:

  • 49652-49653 (Laparoscopy, surgical, repair, ventral, umbilical, Spigelian or epigastric hernia)
  • 49654-49657 (Laparoscopy, surgical, repair, incisional hernia)

Guidelines for Coding Hernia CPT Codes for 2023 in ASCs

The codes 49591–49596 and 49613–49618 describe the repair of anterior abdominal hernias (epigastric, incisional, ventral, umbilical, Spigelian) via any approach (open, laparoscopic, robotic). 

The 49591–49596 and 49613–49618 codes should only be reported once, based on the size of one or more anterior abdominal hernia(s). In the case of both reducible and incarcerated/strangulated anterior abdominal hernias being repaired in the same operative session, both are reported as incarcerated/strangulated.

For example, a 2 cm reducible initial incisional hernia and a 4 cm incarcerated initial incisional hernia separated by 2 cm are reported as initial incarcerated hernia repair. It must be reported with code 49594 and a craniocaudal distance of 8 cm. 

The codes 49621 and 49622 describe the repair of parastomal hernias (initial or recurrent) by any surgical approach (open, laparoscopic, robotic). Meanwhile, CPT code 49621 refers to the repair of a reducible parastomal hernia, and CPT code 49622 refers to the repair of a strangulated or incarcerated parastomal hernia. In parastomal hernia repair, no key factors required separate additional codes, such as size or recurrence of the hernia.

Surgical mesh implants or other prosthetic devices are included in 49591-69596, 49613-49618, and 49621-49622 and are not to be reported separately, regardless of the procedure (open, laparoscopic, robotic). Report add-on code 49623 along with CPT codes 49591–49596, 49613–49618, or 49621–49622 for total or near-total mesh removal. Also, check codes 11004, 11005, 11006, and 11008 for removal of infected mesh.

CPT Codes for ENT 

An updated code for radiofrequency remodeling has been added to ENT:

  • 30469Repair of nasal valve collapse with low energy, temperature-controlled (ie, radiofrequency) subcutaneous/submucosal remodeling

Several revisions have been made to the descriptions of bone-anchored hearing devices. Here are the additions:

CPT CodesDescription
69716Implantation, osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, within the mastoid and/or resulting in removal of less than 100 sq mm surface area of bone deep to the outer cranial cortex
69717Replacement (including removal of existing device), osseointegrated implant, skull; with percutaneous attachment to external speech processor
69726Removal, entire osseointegrated implant, skull; with percutaneous attachment to external speech processor

CPT Codes for Total Disc Arthroplasty

CPT CodeDescription
0163TTotal disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), each additional interspace, lumbar (List separately in addition to code for primary procedure)

CPT 22860 has been replaced with this code, but the description remains the same.

CPT Codes for Nerve Block

Changes have been made to nerve block codes and this includes all imaging guidance. 

CPT CodeDescription
64415Injection(s), anesthetic agent(s) and/or steroid; brachial plexus, including imaging guidance, when performed

Tips for Coding CPT 2023

Ensure your ambulatory surgery center is prepared for the new year by reviewing all the latest, revised, and deleted codes before another year ends. Keep your practice management software up-to-date with the new CPT codes. Lastly, ensure that surgeons in your ASC know the 2023 CPT code changes before they perform procedures.

Tap Into Our Expertise

At 5 Star Billing Services Inc, we offer the highest level of performance for high-quality medical billing and coding. Save your money by outsourcing to a professional pain management billing service.

Schedule a call with our experts today!

Leave a Reply

Your email address will not be published. Required fields are marked *

  • © 2024 5 Star Billing Services, Inc.