# hernia code



## herrera4 (Nov 3, 2010)

What code would be used for a lap repair of scrotal hernia? would this fall under an inguinal hernia repair or unlisted? Thank you


OPERATIVE FINDINGS:  Included a massive left scrotal hernia. Dissection was quite difficult due to the chronicity and size of the hernia and required approximately two hours to complete; the usual procedure takes approximately 35 minutes for the operative portion of the procedure.
 DETAILS OF THE PROCEDURE:  The patient was brought to the operating room and placed in supine position. Following induction of general anesthesia, he was prepped and draped in the usual sterile fashion using ChloraPrep. After infiltration of local anesthetic, curvilinear incision was made on the inferior aspect of the umbilicus. This was carried down through skin and subcutaneous tissue. The left rectus sheath was incised sharply and using gentle digital dissection, the plane between the rectus muscle and the rectus sheath was developed. The balloon dissector was inserted and this was advanced to the pubic tubercle under laparoscopic control, first in the midline and then was deflected to the left. The structural balloon was then inserted. Pneumopreperitoneum was established. Additional ports were placed in the suprapubic region and mid abdomen near the midline. The very large scrotal hernia sac was noted. The hernia had been reduced manually by the operating surgeon prior to the prep. A very large indirect sac was noted. Using meticulous two-handed dissection, the sac was freed from the cord structures and the scrotum. As noted above, this was quite difficult due to the chronicity and size of the hernia. The dissection, as noted above, took approximately an hour and a half to complete. Once we had freed the hernia sac from the scrotum, the sac was repaired using running 2-0 silk suture. Operative area was irrigated with Ancef solution. The large 3D Max mesh was chosen for the repair. This was rinsed in Ancef, placed in preperitoneal space and secured with multiple Sorbafix tacks. The fit of the mesh was tested by partial desufflation of the preperitoneum and the repair was noted to be quite intact with the mesh being held against the abdominal wall by the expanding peritoneum. Final irrigation was carried out. There was no active bleeding noted. The pneumopreperitoneum was evacuated. Ports were then closed with interrupted sutures of 0 Vicryl followed by subcuticular 4-0 Vicryl for the skin. This was followed by Steri-Strips, dry sterile dressing and Tegaderm.


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## jettagirlfl (Nov 19, 2010)

scrotal hernia is considerd inguinal : 49650


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## preserene (Nov 19, 2010)

Yes Jetta is correct . here is  the  validation of the classification:

Scrotal hernia: It is an indirect inguinal Hernia. ICD -9- 550.x

Please look into the clip for an easier Classification of Inguinal Hernia:
A classification should be simple to use and easy to remember: (A) indirect hernia, (B) direct hernia, (C) scrotal or giant hernia, (D) femoral hernia. A and B can be classified as (0) uncomplicated, (1) posterior floor defect, (2) posterior floor defect plus defect in the anterior part of the inguinal canal. All four types (A-D) may be either primary or recurrent. In this classification combined femoral, indirect and/or direct hernias can be categorized by using the types A, B, C, or D as in a modular construction system. The category "other" is reserved for rare types of hernia, e.g., obturator hernia, Spieghelian hernia. 
Aggravating factors are included: Diabetes, obesity, age above 65, constipation, ASA III or more and cigarette smoking. This classification may be helpful to evaluate outcome of hernia repair with regard to patient related factors and the increased demands for the surgeon and the staff. In some health care systems the general belief is that all hernias are equal and be managed equally. However, groin hernias may be complex and need individual treatment.


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## herrera4 (Nov 23, 2010)

Thank you!!


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