# Repair Inguinal herina



## knperry (Oct 11, 2012)

I'm not sure what code to use for a open left inguinal hernia repair with plug and patch mesh.  I think the codes for this surgery should be 49565 add on 49568 but I'm not sure  because the 49565 doesn't say inguinal it says incisional or ventral hernia.  Please read the notes below.  Your input would greatly be appreicated.

After informed consent was obtained, the patient   
was prepped and draped in sterile fashion.  A 7-cm skin incision was made     
approximately half the distance between the anterior superior iliac spine and 
the pubis.  Electrocautery and sharp dissection were used to dissect down to  
the level of the external oblique fascia.  This was incised.  Further         
dissection revealed a direct inguinal hernia.  The hernia sac was dissected   
free from the cord, taking care to preserve the vas deferens and other cord   
structures.  The hernia sac was ligated high and amputated.  A Vicryl plug was
placed in the defect and secured in place with 3-0 Vicryl suture.  The mesh   
patch was then placed over the defect and secured at the level of the pubis   
with a 3-0 Prolene stitch, which was run along the shelving edge and the cord 
was placed through the keyhole of the mesh.  3-0 Vicryl was used to close the 
wound in 2 layers and the skin was closed with a 4-0 running subcuticular     
Monocryl.  The wound was dressed in sterile fashion, and the patient tolerated
the procedure well.


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## Grintwig (Oct 11, 2012)

49565 is not the correct code to use for an inguinal hernia. The code range for inguinal hernias is 49491-49525 depending on the age of the patient and whether or not the hernia is initial, recurrent, incarcerated/strangulated, or sliding. You can only use +49568 with incisional and ventral hernia repairs with mesh. The mesh is included in the repairs of other hernias. 
So neither of those codes are correct.


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## knperry (Oct 11, 2012)

So the part about A 7-cm skin incision was made in the doctors notes don't make difference?  That is the part that confused me.


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## knperry (Oct 11, 2012)

Also would the part about the hernia sac was dissected 
free from the cord, taking care to preserve the vas deferens and other cord 
structures, be the strangulated description?


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## syllingk (Oct 12, 2012)

No. No strangulation is mentioned in the note. The 7 cm incision is how they started the surgery. When it says incisional hernia they mean the hernia is from/in a place of a previous surgery where there was an incision made, not meaning how the surgery is performed. 
If it is an adult and an initial hernia then it sounds like it would be 49505. Mesh is included.


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## knperry (Oct 12, 2012)

Do you mind pointing out where it talked about the strangulated part?

Thanks


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## syllingk (Oct 12, 2012)

What you posted doesn't say it is strangulated or incarcerated or anything so I am assuming that is the whole note and it is reducible.


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## knperry (Oct 12, 2012)

That is all the notes on the surgery.  Is this one of those situations when I need to consult the doctor to find out?


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## syllingk (Oct 12, 2012)

I would since you have two code choices. Reducible or incarcerated.


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## knperry (Oct 16, 2012)

Thank You


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## dianakayf (Nov 6, 2012)

*Irreducible hernia*

We are having a discussion with hospital coders regarding irreducible hernia's.  I agree that they are considered incarcerated according to the ICD-9 book.  But their encoder puts 550.11 with 49520.  To me that is billing a incarcerated ICD code with a non-incarcerated repair code.  Since this was recurrent/over 5 I think it should be 49521.  Any other opinions?  I have never used the 3M Encoder.  But a little logic says that ICD and CPT codes should agree???  And WHEN the H&P states 'could not be reduced' than it is incarcerated ICD9???

Diana Franklin, CMRS, CPC


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## cwpierce (Nov 6, 2012)

I do not see any mention of obstruction in the dictation so I would code this as a 49505 providing that the patient is 5 years or older. Dx 550.90.


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## dianakayf (Nov 8, 2012)

*3m encoder*

The hospital coder is telling me because she uses the 3M Encoder and I do not - that we will not agree on coding???  I would think an encoder such as 3M would be accurate - but she is putting irreducible in and getting an incarcerated dx code - I understand that part.  But then she says it points to a CPT that IS NOT incarcerated.  That part makes no sense and would it not have to say irreducible or could not be reduced somewhere in the physician's H&P or OP report???  It is my assumption that if the hospital and professional codes do not agree that it would throw up a red flag to CMS????  Any hospital coders on here that can shed some light on this?????  You can email me privately if you like at dianakayf@gmail.com

Diana Franklin, CMRS, CPC


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