# HELP! Bladder foreign body and complex closure!



## t_ferg07@yahoo.com (Jun 11, 2014)

HELP!

I have scratched my head any way possible trying to find info on billing this type procedure. A patient had hernia repair and apparently mesh had got in through a small hole in the bladder. Now my physician is removing the foreign body in the bladder, but by doing an open procedure. Then there was a complex closure of the bladder. Below is the OP report.

...There was a small hole in the bladder. We filled up the bladder through the Foley cath and noticed a small hole. I just opened up the bladder in a vertifical fashion from this hole taking it down towards the anterior surface of the bladder. There were two areas of possible tacks still within the bladder and then there was an area clearly where the mesh had been removed from the bladder that created a hole, and there were probably tacks in that as well. I dissected the mesh off of the posterior surface of the baldder and excised a large piece of mesh, which was adherent to the posterior bladder wall. There was no other injury to the bladder noted. At this point, with the large piece of mesh excised, I did a two layer closure using a 3-0 running Chromic suture. 

Any input you could provide would be MUCH appreciated!!! Thanks in advance!


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## nateich (Jun 11, 2014)

Leaning towards unlisted 53899 and using 51050 to compare......from SuperCoder. Let us know what you decide.

Clinical Responsibility

This code is used when incision of Urinary bladder is done for removing the bladder calculus, without vesical neck resection.

Physician cleans the abdominal area with betadine. Under general or spinal anesthesia an incision is made just 2cm above the pubic symphysis. The skin is exposed and dissection of local tissues is done to locate bladder. The bladder is checked by inserting the syringe and draining out the urine. The incisions are made in bladder wall and are enlarged according to the size of stone. Neck of bladder is spared and never resected under this procedure. The calculus is removed with the help of forceps or using a grasping device. The bladder is closed and repaired by suturing. The penile catheter (vaginal catheter in females), is connected for draining of urine and drainage tube is attached because urine leakage occurs from the site which can lead to abscess formation. The site is sutured and dressing is done.

The drainage tube and catheter are removed within 5 days.

Tips

Scenario: My urologist did an open abdominal exploration with cystotomy and removal of exposed mesh that had eroded through the patient's bladder. He also removed adherent stone material on the mesh. How should I code this procedure?

Answer: Report 51050 (Cystolithotomy, cystotomy with removal of calculus, without vesical neck resection) for the mesh and stone removal from within the bladder.

Additionally: If the removal was complicated and extended the surgery a significant period of time, you should consider appending modifier 22 (Unusual procedural services) to 51050. Remember that your payers won't accept a modifier 22 claim unless you can provide convincing evidence both in the operative report and the cover letter that the service or procedure was truly "out of the ordinary" and significantly more difficult or time–consuming than a usual 51050 procedure


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## t_ferg07@yahoo.com (Jun 12, 2014)

Well, there aren't actually stones present, they are tacks from a previous hernia repair, as is the mesh. I think I may have to use an unlisted procedure and hope the insurance is a reasonable one to deal with!   Thanks again!


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## nateich (Jun 12, 2014)

I should clarify, the procedure/approach used to get to the tacks is essentially the same as removing calculus in 51050, hence comparing the unlisted to 51050.


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