# SBO 2nd incar ventral hernia & enterotomy



## bwerner (Jul 22, 2008)

Hello,

My surgeon did lap lysis of adhesions on this lady two days prior to her SBO, so she is in a post op period. He noted when doing this procedure that she had a small ventral hernia that wasn't causing her any problems. 

Now, he is going in to fix her ventral hernia because it is incarcerated with her small bowel, he went in laparoscopic and after pushing the bowel back through the defect there was noted there was an enterotomy, so he coverted to open procedure.  He repaired her small bowel and repaired the ventral hernia.

My question is 1. Can I charge for the repair of the small bowel and the incarcerated ventral repair. My surgeon said that yes he did cause the enterotomy by reducing the bowel but he had to push it back through, so I'm not convinced that I can't charge that for being his fault. 2. I thought to use the .58 modifier for staged or related since he previously saw the hernia but didn't believe that that is what was causing her abd pain, but if the lysis of adhesions didn't work then he would try fixing the hernia at a later time. Tell me what you think.

Thanks,
Becky Werner


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## cmartin (Aug 14, 2008)

I would only charge for the rpr of the incarcerated hernia, not for rpr of the enterotomy, and I would use a -79 since there's no reason to suppose that the hernia became incarcerated because of the prior laparoscopic lysis of adhesions.
C.Martin, CPC-GENSG


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