# Bilateral inguinal hernias, incisional hernia



## MUS (Oct 24, 2019)

Good Morning, I need help with the below encounter. 
Two inguinal hernias were repaired laparoscopically. Did the approach is through incisional hernia defect?
Any input is greatly appreciated.

PREOPERATIVE DIAGNOSIS:
Bilateral inguinal hernias, incisional hernia
POSTOPERATIVE DIAGNOSIS:
Bilateral inguinal hernias, incisional hernia
OPERATION:
1. Robotic bilateral inguinal hernia repairs with mesh.
2. Open incisional hernia repair

INDICATIONS:
This is a patient who presented with bilateral inguinal hernias as well as a hernia above the
umbilicus at a previous lap chole surgical site.
Options were discussed with the patient and he wished to have all repaired
simultaneously. Therefore, robotic transabdominal approach was
planned.
DESCRIPTION OF PROCEDURE:
The abdomen was prepped with ChloraPrep and draped sterilely.
Pneumoperitoneum was obtained with a Veress needle at the umbilicus, followed
by placement of three 8-mm robotic trocars, and the robot was docked. I began
by excising the peritoneum and opening a peritoneal flap on the left side,
lowering this flap, all the way down to the area of the left inguinal hernia.
The hernia sac was dissected off the spermatic cord and contents and reflected
back into the abdomen. Once complete, a ProGrip mesh was then placed through
one of the trocars and placed strategically on the area of the hernia covering
from Cooper's ligament medially and inferiorly all the way to cover the
myopectineal orifice. The peritoneum was then closed using a running V-Loc
suture. The same exact procedure was then undertaken on the right side,
creating a peritoneal flap dissecting the hernia sac and placing the right-
sided ProGrip mesh. Peritoneum was closed in the same manner. The abdomen
was then desufflated. Trocars were removed under visualization and the central incision was extended
allowing exposure of the incisional hernia in the midline. This was closed with interrupted 0 ethibonds
followed by skin incisions with 4-0 Monocryl and Dermabond.


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## dkissel (Oct 24, 2019)

What is the exact question you need help with here?


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## MUS (Oct 24, 2019)

Should I code both inguinal hernia bilateral(Robotic) and incisional hernia(Open)
K4020 Inguinal CPT 49650-50
K432 Incisional CPT 49560
OR
 Is it only incisional CPT 49654 Laparoscopy, surgical repair incisional hernia;reducible

Please advise. Thank you


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## dkissel (Oct 24, 2019)

You can code the bilateral inguinal hernia repair. The incisional repair is incidental and therefore not billable.


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## MUS (Oct 25, 2019)

Okay perfect. Thank you so much.


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