# Need help w/ a fascial defect w/ mesh repair



## karey (Jan 17, 2013)

The patient had an abdominal mass removed which created a defect and the MD repaired the defect by applying mesh. Is there a code for this? Everything I find is for hernia repair. Please see below--


 ....A large defect was noted therefore on the right side where the abdominal mass [FONT=COURIER,sans-serif]had previously been located.Great care at that point was taken to [/FONT][FONT=COURIER,sans-serif]further dissect off the subcutaneous tissue layers in order to identify [/FONT][FONT=COURIER,sans-serif]the fascia and a Prolene mesh was then placed and sutured in place using [/FONT][FONT=COURIER,sans-serif]a series of interrupted Prolene sutures, which fixed the mesh to the [/FONT][FONT=COURIER,sans-serif]fascial defect on the right-hand side.Once the Prolene mesh was in [/FONT][FONT=COURIER,sans-serif]place and tacked down, the fascia was then repaired using two running #0 [/FONT][FONT=COURIER,sans-serif]looped Maxon sutures from each corner.  These were tied together in the [/FONT][FONT=COURIER,sans-serif]midline.Great care was taken in order to avoid excess tension on the [/FONT][FONT=COURIER,sans-serif]newly placed mesh.  The subcutaneous tissues were then irrigated.A [/FONT][FONT=COURIER,sans-serif]Jackson-Pratt drain was then placed in the subcutaneous tissue above the [/FONT][FONT=COURIER,sans-serif]fascia.  Several interrupted 2-0 Dexon were then placed in the [/FONT][FONT=COURIER,sans-serif]subcutaneous tissue layer and the skin was closed with staples. [/FONT]


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## BMCS-mjgriffith (Jan 17, 2013)

*Need help w/a mesh repair*

Hello Karey,

I need some additional information in order to better assist you. Was the fascial defect closure done during the same operative session as the abdominal mass excision or was the closure performed during a later operation session? If the closure was done at the same time as the excision, which CPT & ICD-9 code(s) are you using for your primary procedure-"abdominal mass removed"?  

I have found a couple different articles that may also help you - see the links listed below. 

http://news.aapc.com/index.php/2010/06/expose-the-layers-of-abdominal-wall-reconstruction/

http://www.facs.org/fellows_info/bulletin/2011/socioeconomic0911.pdf

You may also contact me via my email address: mj-griffith@hotmail.com and please allow at least 24 hours for a response. 


MJ Griffith, CPC
Warren Ohio Chapter, Treasurer


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## karey (Jan 17, 2013)

Yes it was done during the same session as the abdominal mass removal. My doc has given me CPT codes 22905 and 49568 (which I know is wrong) w/ a dx of 182.0-endometrial cancer. The path says "Metastatic endometrioid adenocarcinoma" was found so I was going to use 198.89-Secondary malignant neoplasm of other specified sites w/ 22905 and possibly 15734 w/ a dx of 879.5-Abdominal wall, lateral, complicated.

What do you think?


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