# coding for hernia



## ronniesans (Jun 20, 2012)

Hello.

I've been taking the practice tests in preparation for certification, and I have a question about the rationale for this question:


A 70-year-old female who has a history of symptomatic ventral hernia was advised to undergo laparoscopic evaluation and repair. An incision was made in the epigastrium and dissection was carried down through the subcutaneous tissue. Two 5-mm trocars were placed, one in the left upper quadrant and one in the left lower quadrant and the laparoscope was inserted. Dissection was carried down to the area of the hernia where a small defect was clearly visualized. There was some omentum, which was adhered to the hernia and this was delivered back into the peritoneal cavity. The mesh was tacked on to cover the defect. What procedure code(s) should be used?​
Here are the possible answers:

A. 49560, 49568
B. 49653
C. 49652
D. 49653, 49568​
And here is the rationale for the answer:


The patient is having a laparoscopic ventral hernia repair, eliminating multiple choice answers A. The hernia is incarcerated as the report states that omentum was adhered to the hernia and was delivered back into the peritoneal cavity, eliminating multiple choice answer C. A parenthetical note in the code descriptive for the laparoscopic hernia repair codes state, that mesh insertion is included when reporting these codes when performed, eliminating multiple choice answer D.​
I don't understand this rationale. Shouldn't the answer be c) 49652?  

Any comments would be appreciated. Thanks!


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## Hopp (Jun 21, 2012)

*Test Prep*

Did you think about choosing B-49563(incarcerated and that code includes mesh insert)
Deb,CPC   Sorry I did mean for u to choose B  ( but i meant 49653)


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## amny1212@yahoo.com (Jun 21, 2012)

I agree. 49653 is the answer.


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## amny1212@yahoo.com (Jun 21, 2012)

woops! i meant 49653.


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## ronniesans (Jun 21, 2012)

But can you tell me why it's not 49652? I don't understand the rationale for why it was eliminated.


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## syllingk (Jun 21, 2012)

49652 specifies the hernia as reducible. Op note says it was incarcerated so the correct code is 49653.


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## ronniesans (Jun 21, 2012)

Oh. I see. Incarcerated because it had the omentum and was pushed back into the cavity. 

Thank you.


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## codedog (Jun 21, 2012)

I thought incarcerated  herina tissue cannot be pushed back into normal position


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## syllingk (Jun 21, 2012)

Yes but they don't mean once you've opened the patient up. Of course it can be reduced then..


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## codedog (Jun 21, 2012)

undestand now,


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