# Hernia repair with omentectomy



## erubritz (Sep 18, 2013)

*Thoughts on how you all would code this operation??* 


OPERATION:  Incarcerated umbilical hernia repair with partial omentectomy

PROCEDURE:  Infraumbilical skin incision made with the scalpel through the skin and subcutaneous tissues was separated from the fascia with sharp dissection.  Hernia sac opened and contains venous congested, partially ischemic appearing omentum.  The omentum in the hernia sac is separated from the fascia.  The omentum is transected in sements using Vicryl suture.  The hernia sace is transected.  The fascial defect is free of hernia sac and omental contents.  Posterior sweep of the fascia is unremarkable.  Abdominal viscera identified.  Given the venous congestion and partial ischemia of the omentum removed, I decided not to place any mesh/prosthesis.  Fascia, subcutaneous tissues and dermis infiltrated with Marcaine with epinephrine.  Figure-of-eight interrupted Prolene sutures (0 Prolene) are used to close the fascial defect.  The subcutaneous tissues were elevated off of the anterior fascia prior to fascial defect closure.  Hemostasis achieved using electrocautery and stick ligature Vicryl ties where necessary.  Subcutaneous tissues were reapproximated from deep to anterior with interrupted layered Vicryl sutrue.  Inversion was done of the dermis of the umbilicus trying to recreate an inverted umbilicus with Vicryl suture.  Skin edges reapproximated with subcuticular 4-0 Vicryl suture.  Mastisol, Steri-Strips and dry sterile dressings applied.


I guess I should start out by saying that my doctors are very RVU driven.  So, originally I was going to only code the hernia repair (49587) but after reading the op report and looking at the codes, my question is:  Can I bill for the partial omentectomy (49255) instead of the hernia repair?  Or can I only bill for the hernia repair since that was the original procedure?  Any and all help would be appreciated!!!


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## nrichard (Sep 18, 2013)

*I wouldn't do it!*

In the general surgery coding companion from Ingenix the omentectomy reads: "The omentum is mobilized from the stomach and colon, divided from its blood suply, and removed." This doesn't sound like what your MD is describing.
I would go with the hernia repair code, with modifier 22. 
 My physicans are paid by RVU too, so I understand the situation. However my billing software recalculates the physician payment w/ this modifier.


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## erubritz (Sep 19, 2013)

Thank you!!!


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