# Repair Multiple hernias



## Trendale (Jun 22, 2009)

Hello,
Can I get clarification on coding multiple hernias? There has been previous postings regarding coding 2 hernias or bilateral hernias. The physician doucumented 5 hernia repairs. Does the documentation has to actually state how many he repaired vs how many defects? Because it is a defect, does not actually mean he repaired it, and it could be incidental? If incidental, would this be included? I beleive I should code 49654-22, based on the fact that he intentionally  planned to repair the large hernia in the pelvis area that was causing the diastasis of the muscle, he also stated he found 4 other hernia defects in different areas, and he also spent 1 and 1/2 hr lysing adhesions. I did not see where he stated how many he repaired, he stated how many defects there were. ( Does it matter if it was incidental?) Please let me know your thoughts after reading the following report:
preop dx-Incisional hernia     p/op dx- Multiple incisional hernias
Gross op Findings:
Upon entering with the laparoscope, the patient had a large amount of adhesions. We spent about 1 and 1/2 hr just lysing adhesions so that we can get to the pathology. In addition, the patient had 5 hernias. There was a very large one from a previous C section or hysterectomy, was causing diastasis of the muscle and exposure of a very large hernia.
Description of Operation (Summarized)
A 12 mm port was now placed through this incision followed by the 5 mm laparoscope. Under direct lap vision, a 5 mm port was placed in the LT lower quandrant, we immediately began to lyse adhesions (1 1/2 hr)
once we had taken down the adhesions, we were now able to see the hernia defect. We appreciated about 5 hernia defects in continuity with each other. She had about 3 of them in the upper abdomen and 2 in the pelvis region including a very large one in the pelvis. we now chose a peice of mesh of proceed that was about 15X 30cm, the largest one that you can find. The mesh was placed, trocars removed, etc.

Thanks!


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