# paraileostomy hernia repair



## Leanne (Jan 29, 2009)

Patient has small bowel obstruction secondary to paraileostomy hernia.  Expl. laparotomy, extensive lysis of adhesions and suture repair of paraileostomy hernia were performed.  There was no revision of the ileostomy.  Would this be coded as an incisional hernia repair? or lysis of adhesions w/ mod 22?


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## sundaey (Jan 29, 2009)

According to code correct, LOA is not separately reportable, irregardless of how extensive it was. And, if you look at the surgery guidelines in the cpt book on pg. 47, any procedure that is designated as a "separate procedure" cannot be reported separately if it is an integral part of the primary procedure.
Hope that helps.


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## Leanne (Jan 29, 2009)

Thanks, I guess my confusion is whether it even falls under the category of an incisional hernia.  That's why my thought was to code as just LOA w/ mod 22.

Here's part of the op note:

_Over prior surgical scar in the upper abdomen a 10cm incision was made.  The skin incision continued down through subcutaneous tissue until identification of the linea alba...The dissection started meticulously for the next 45 min to an hour or so for lysing adhesions of small bowel to small bowel and small bowel to the anterior abdominal wall.  Once the small bowel was completely cleared of all surrounding tissues and scar then it was run from ligament of Treitz to the point of the hernia.  The distal segment of small bowel was looped inside the ileostomy and causing a hernia.  This was finally reduced.  That segment was found to be somewhat inflamed with edema but it was not compromised and without any sign of ischemia...The hernia ring was small enough that it needed only to be repaired by suture without the use of any mesh._


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