# cpt 49560



## BFAITHFUL

can anyone help me with the following op report?  


patient prepped and draped in the usual sterile manner and the operation was commendced by creating  the inferior incision.  The dissection was tedious and difficult because of the amount of scar tissue as a result of the previous two C sections, but eventually, the entire abdominal panniculus was freed as well as circumscribing the umbilicus andtaking the soft tissue up to the level of the xiphisternum.  The defect of the ventral hernia was 10cm X 6 cm.  This ventral hernia was reduced, the contents reduced and the sac closed with interrupted inverted simple sutures of ) Tevdek.    The umbilical hernia sac was then approached and incised with cutting cautery and once again the contents peel free from the stalk of the umbilicus reduced into the peritoneum and this sac closed with interrupted simple sutures of the same.   A belly button was sewn in place withinterrupted simple sutures of 4-0 PDS Vicryl.          A layered repair of the rectus diastasis was then commenced with interrupted inverted simple sutures of ) Tevdek followed by a running suture of ) Tevdek.  Drains were placed above and below the umbilicus.  Excess skin was removed as necessary.  The neoumbilical opning was created and the umbilicus sewn into placed with interrupted simple sutures of 4-0 nylon.  A layered closure of the low lying suprapubic incision was closed with multiple layers of interrupted inverted simple sutures of 3-0 PDS followed by 3-0 Dexon o the same nature and running intracuticular suture of 3-0 Dexon.         After completion of the procedure, the drains were then put in place and sewn in place with 3-0 nylon were attached to bulb syringes.           The abdomen was cleansed and umbilicus was dressed with Xeroform gauze and Neosporin ointment.  incision was dressed with benzoin and steri-strips  Multiple ABD's were applied to the abdomen to protect the abdomen and the skin from the overlying drains.  The patient wasmoved on to the stretcher and the binder was applied. 



Now here's what I think, cpt 49560 for the ventral hernia but don't think i should code 49505 for the umbilicial hernia since no separate incision was made to get to this hernia,   and as far as cpt 15830 for the panniculectomy, according to CCI edits, it states the following:

Removal of excessive skin and subcutaneous tissue(panniculectomy)
at the site of an abdominal incision for an open procedure
including hernia repair is not separately reportable. CPT code
15830 should not be reported for this type of panniculectomy.
However, an abdominoplasty which requires significantly more work
than a panniculectomy is separately reportable. In order to
report an abdominoplasty, CPT requires the physician to
report an infraumbilical abdominal panniculectomy (CPT code 15830
plus the add-on CPT code 15847 for the abdominoplasty.
Since NCCI bundles CPT code 15830 into abdominal wall
hernia repair CPT codes, a provider should report CPT codes 15830
plus 15847 with modifier -59 appended to CPT code 15830 in order
to report an abdominoplasty with an abdominal hernia repair CPT code.

But i don't see 15847 in order to be able to bill with cpt 15830?

Please help????????????

Thank you


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