# Large bowel obstruction secondary to incarcerated ventral hernia



## bill2doc (Dec 1, 2011)

Large bowel obstruction secondary to incarcerated ventral hernia 

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Op reads: General endotracheal anesthesia was established. The abdomen was prepped and draped in the standard fashion. An upper midline incision was made overlying the hernia down to the umbilicus. The hernia sac was immediately visible. There appeared to be thin serous fluid within it but no evidence of gangrene or purulent or feculent material. The hernia sac was then incised and the bowel examined. The bowel that was incarcerated within th ehernia appreaded quite viable with no evidence of strangulation or necrotic tissue. There was a significant amount of omentum that was also incarcerated within the hernia and this also appreared to be quite viable. The hernia defect was extended at either end to allow evaluation of the intra-abdominal bowel. The colon was traced to the ascending portion of the large bowel and while dilated there was no evidence of perforation noted. The distal colon appreaded to be healthy and intact as well. The omentum was then placed within the abdomen and the hernia drfect was then subsequently perpared for repair. The hernia sac was dissected free or the surrounding tissue and passed off the field as specimen. The fascia itself was evalutated and appeared to be reasonably healthy laterally circumferentially around the hernia defect. There was a small supraumbilical fascial defect that was incorporated into the repair. The defect was measured to be approx 8x6cm. A 14x17 cm composix mesh was then chosen to allow for approx 4-5 cm of overlap on either side of the defect. The mesh was then stuured into place in strong healthy fascia using #1 Vicryl in an interruped fashiion. Once these sutures wer placed circumferentially there was no evidence of gaps between the sutures that would allow a loop of bowel to come in. The sutures were then tied. Once mesh placed and bowel had been appropriately reduced it appreared that the fascial edges could be brought togehter completely so a #1 looped PDS suture was used to reapproximate the fascial edges in a running fashion to improve coverage over the mest and reinforce repaor. Would was then copiously irrigated w/normal saline and hemostasis was assured. Skin was closed with staples. Steri-Sprips, dressing abdom binder applied....

Struggling with 49000, 49561 and 59652... can you help with codes and possible modifiers.....sorry for spelling!


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## Janet Fairhurst (Dec 1, 2011)

*jfairhurst*

Did you mean 49652? If so, I don't think it would be that since this appears to be an open procedure. I don't think you can use 49000 and 49561 together. I think you would code 49561 and 49568. That's my 2 cents.


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## bill2doc (Dec 2, 2011)

Well since I'm clueless, your 2 Cents is worth millions!  Thanks!


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