# mesh removal not using the add on code



## tgenia (Dec 21, 2011)

Hi Everyone,
I am trying to code a procedure we performed with another group, we assisted with the main procedure and then also removed mesh but code 11008 has a specific range to refer to ( 10180,11004-11006 ) I was also thinking of maybe using cpt 49402 instead, can anyone give me an insight on this and thank you. I attached the operative note below
cpt 54530/80
cpt 49402/59


 DATE OF SERVICE:  11/16/2011


SURGEON
 MD, FACS


CO-SURGEO, MD


ASSISTANT

UNIVERSITY OF MINNESOTA 


PREOPERATIVE DIAGNOSIS
Chronic right groin pain and testicular pain. 


POSTOPERATIVE DIAGNOSIS 
Chronic right groin pain and testicular pain. 


PROCEDURE
1. Explantation of keyhole mesh and plug. 
2. Orchiectomy 


ESTIMATED BLOOD LOSS
10 cc. 


COMPLICATIONS
None. 


INDICATIONS
Mr. ---------- is a 47-year-old gentleman who underwent a right inguinal hernia
repair approximately 10 years ago. It was done laparoscopically, and he had a
recurrence. He subsequently had an open repair of that recurrence and
developed chronic pain that had been very bothersome over the last 7 years or
so. We tried multiple modalities to help control his pain, and we were never
really totally successful. We discussed explantation of the mesh, and
possible orchiectomy. He discussed the situation with Dr.  as well. 


We discussed the potential risks, benefits, and alternatives at great length.
We discussed issues that included, but were not limited to, anesthetic risk,
hemorrhage requiring transfusion, the risk of transfusion, infection, heart
attack, stroke, death, recurrence of the hernia, injury to vessels and nerves
in the region, etc. He had a full understanding of the situation and elected
to proceed. We should also note that we discussed the possibility that
explantation and orchiectomy would not cure his chronic pain. Again, he
elected to proceed. 


OPERATIVE FINDINGS
The cord was entrapped within the mesh plug. This was removed, as was the
testicle and cord. There were no complications. 


DESCRIPTION OF PROCEDURE
The patient was brought to the operating room, placed in supine position,
prepped and draped in the usual sterile manner. An elliptical incision was
made around the right groin incision, which was somewhat hypertrophic. The
subcutaneous tissue was divided using electrocautery. The external oblique
aponeurosis was identified and incised. We identified the cord structures and
the underlying mesh. The mesh was grasped at the pubic tubercle and the
sutures were cut. It was then bluntly dissected with the use of some
electrocautery away from the underlying musculature. The tails were removed.
The cremasteric muscles were divided. The inferior epigastric artery was
identified and preserved throughout the operation. 


With the keyhole mesh removed, the cord structures were well exposed. Dr.
 then performed the orchiectomy, and in doing so we removed the mesh
plug. Please see his dictation. 


The mesh plug was grasped and retracted. We cut the adhesions of the mesh
circumferentially as we dissected down to the base of the mesh plug. The cord
was then clamped and ligated and divided. The mesh was in good position for
the most part, but inferiorly it had pulled separated from the vessels and
that is where the recurrence had occurred. This was then sutured down to the
inguinal ligament to essentially help prevent a recurrence of the hernia.
Interrupted 0 Nurolon sutures were used. The wound was copiously irrigated.
The spermatic vessels had been suture ligated. There was no bleeding. The
external oblique aponeurosis was closed with a running 3-0 Vicryl. We
injected copious amounts of 0.25% Marcaine. The subcutaneous tissue was
approximated with a running 3-0 Vicryl. The skin was closed with 4-0 Vicryl
subcuticular stitch. Steri-Strips were placed. The wounds were dressed. The
patient was brought to recovery in good condition. There were no
complications. The patient tolerated the procedure well. 






Dr, , MD, FACS


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## Lujanwj (Dec 23, 2011)

I'd suggested 20680 - Removal of Implant, Deep.  Don't worry about mesh not being an example (eg) in code as the mesh is still considered an Implant.   49402 would be in the cavity, at least that's my interpretation of the code.  

Good Luck!


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## FTessaBartels (Dec 27, 2011)

*Please REMOVE physician / med student names*

A scrubbed note eliminates ALL identifying information ... name/location of hospital/facility, physician names, etc.

*Please remove this information from your posted note to comply with HIPAA. *

F Tessa Bartels, CPC, CEMC


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## ajs (Dec 27, 2011)

gterri said:


> Hi Everyone,
> I am trying to code a procedure we performed with another group, we assisted with the main procedure and then also removed mesh but code 11008 has a specific range to refer to ( 10180,11004-11006 ) I was also thinking of maybe using cpt 49402 instead, can anyone give me an insight on this and thank you. I attached the operative note below
> cpt 54530/80
> cpt 49402/59
> ...



It appears that the 49402 would be correct for the mesh removal.  The code 54530 is for Radical Orchiectomy because of a tumor...so I believe the correct code for that procedure is 54520.

And as is also stated here, when you are redacting an op report you must remove ALL identifying information...so that means all the doctors names and facility names as well.


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## FTessaBartels (Jan 5, 2012)

ajs said:


> It appears that the 49402 would be correct for the mesh removal.  The code 54530 is for Radical Orchiectomy because of a tumor...so I believe the correct code for that procedure is 54520.
> 
> And as is also stated here, when you are redacting an op report you must remove ALL identifying information...so that means all the doctors names and facility names as well.



Arelene ... but you included the doctor's names when you quoted the original post ...
Now that original poster has fixed the original, you might want to edit your quote as well.

F Tessa Bartels, CPC, CEMC


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