# hernia repair, infected patch removal, abscess drainage



## sbetts (Jan 25, 2011)

Hi all, 

Could anyone help me with the following report please? 

This was all done laparoscopically. 

Once the abdomen was entered, the adhesions were taken down until the midline was approached. A fibrotic mass was noted, felt likely to represent the posterior pseudocapsule around the intra-abdominal abscess posterior to the Gore-Tex patch graft. This capsule was penetrated with a laparoscopic needle and fluid was aspirated and sent to the lab. The abscess cavity was then entered with scissors dissection, creating a plane close to the parietal peritoneum and gradually creating a disc of pseudocapsule, which was left adherent to underlying omentum. Once this disc of scar tissue was separated from the abdominal wall, the patch was noted to be densely adherent anteriorly. Multiple Pro-Tech tacks were removed and the patch was separated from it's attachments anteriorly and another abscess was encountered between the patch and the skin. This was also drained. The patch was eventually delivered through the LUQ incision. (FOR THIS PART OF THE SURGERY THE PHYSICIAN CODED 49606 AND 49021, WHICH DOESN'T SEEM RIGHT) 

The physician went on to repair the ventral hernia with an AlloMax patch. (49652) 

thanks for the help, 

Shena Betts, CPC 
Physicians' Professional Mgmt


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## Grintwig (Jan 26, 2011)

I don't like those codes either (49606 and 49021) as I do not see any mention of the patient having a large omphalocele or gastroschisis AND the procedures the physician did here were all lap.
I'm leaning toward an unlisted code (49329 unlisted laparoscopy procedure, abdomen, peritoneum and omentum) BUT as these all seem to have been done through the same incision, it could just as easily be that you would add a -22 to the hernia procedure (49652)....especially if the abscesses were in the "approach" path.
I am interested in seeing what others come up with as I have never coded this scenario before.


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## sbetts (Jan 26, 2011)

thank you for responding. What about code 49402 for the infected patch removal?

Shena


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## crabby1 (Jan 29, 2011)

I think 49652 for the hernia repair with mesh insertion,and 49322 for the Laparascopic aspiration. Although the unlisted code may work just as well with 22 modifier.  I believe that 49402 is an open procdure. Hope this helps. 
P Johnson,CPC


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