# Multiple Hernias Repaired



## Jody Mortensen (Jul 23, 2009)

Hi, I need help in coding a laparoscopic hernia repair but am very confused by the procedure description and not good at understanding incarcerated vs reducible.  Any help would be appreciated.  Procedure description: Trocars were placed on the left upper quadrant anterior axillary line & on the left lower quadrant anterior axillary line.  There were no incarcerated contents except for some preperitoneal fat.  This fat was dissected off of the umbilical region & the peritoneum & peritoneal fat were dissected from the abdominal fat caudad for 2 inches.  In the process of mobilizing the falciform ligament, we found a fascial defect to the insertion of the falciform ligament an inch or 2 above the umbilical defect.  The falciform ligament was taken down and an Endoloop Vicryl tie was use to tie it's proximal end towards the liver.  Excess preperitoneal fat was completely excised & removed.  The 2 defects were very small & an 18 x 14 cm peices of mesh was inserted & secured.      Okay my confusion ?'s:  1.)  Does the sentence referring to no contents incarcerated except for preperitoneal fat qualify the hernia as incarcerated?  2.)  How do you code for multiply hernias repaired?  In this scenario 49652-22 or 49652 twice with a 59 modifier?  3.) Does anyone know of a good website with instructions on how to code multiple hernia repair?     Thank you Jody


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## Bella Cullen (Jul 23, 2009)

Jody Hecht said:


> Hi, I need help in coding a laparoscopic hernia repair but am very confused by the procedure description and not good at understanding incarcerated vs reducible.  Any help would be appreciated.  Procedure description: Trocars were placed on the left upper quadrant anterior axillary line & on the left lower quadrant anterior axillary line.  There were no incarcerated contents except for some preperitoneal fat.  This fat was dissected off of the umbilical region & the peritoneum & peritoneal fat were dissected from the abdominal fat caudad for 2 inches.  In the process of mobilizing the falciform ligament, we found a fascial defect to the insertion of the falciform ligament an inch or 2 above the umbilical defect.  The falciform ligament was taken down and an Endoloop Vicryl tie was use to tie it's proximal end towards the liver.  Excess preperitoneal fat was completely excised & removed.  The 2 defects were very small & an 18 x 14 cm peices of mesh was inserted & secured.      Okay my confusion ?'s:  1.)  Does the sentence referring to no contents incarcerated except for preperitoneal fat qualify the hernia as incarcerated?  2.)  How do you code for multiply hernias repaired?  In this scenario 49652-22 or 49652 twice with a 59 modifier?  3.) Does anyone know of a good website with instructions on how to code multiple hernia repair?     Thank you Jody



I would code this as 49652-22 only because dr says no incarcerated contents so that fat surrounding the hernia wasnt causing an obstruction or strangulating the hernia. I would not in this case code for both hernias because he found the other small defect while he was fixing the other one. If he had to make 2 incisions or extend that one incision more then I would say go ahead and bill for the other one as well, but he didn't so i would just stick with the one code.


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## Jody Mortensen (Jul 28, 2009)

*Thank you*

Thank you so much


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