# Lap App with Umbilical Hernia Repair?



## bailsb (Mar 23, 2011)

Any help would be greatly appreciated.  44970 and 49652 with mod 51 on 44970?

OPERATION PERFORMED:
1.  Laparoscopic appendectomy.
2.  Repair of umbilical hernias.

ESTIMATED BLOOD LOSS:  Minimal.

REPLACEMENT:  Crystalloid.

DRAINS:  None.

COMPLICATIONS:  None.

The patient was then taken to the operating room in the supine position.
General endotracheal anesthesia was undertaken without difficulty.  The
patient's abdomen was prepped and draped in usual sterile fashion.  An 11 blade
scalpel was used to make an infraumbilical incision. The patient had a large
ventral hernia and a small umbilical hernia.  A Veress needle was placed, and
low insufflation pressure was converted to high insufflation pressure after
camera visualization being in the abdomen after a 5 mm trocar was placed.  The
patient was then placed in Trendelenburg, left side down, right side up.  Two
trocars were placed, one suprapubically and one subxiphoid under direct camera
visualization.  The patient was morbidly obese. Omentum was manipulated. The
appendix was inflamed and grasped with grasping forceps and mesoappendix was
cauterized with a SonoSurg down to the base of the appendix.  Two Endoloops were
placed at the base of the appendix and incised below the appendix using
SonoSurg. We cauterized the appendiceal stump.  The appendix was delivered to
the Endobag and then removed from the infraumbilical incision and sent to
pathology.  The right lower quadrant was copiously irrigated with normal saline
antibiotic solution and trocars and air were removed.  The linea alba of the
infraumbilical hernia was primarily closed with 0-Vicryl figure-of-eight
fashion.  The subcutaneous tissue was closed with 3-0 Vicryl and subcuticular
5-0 Monocryl.  Steri-Strips were applied.  Marcaine 0.5% was infiltrated in the
wounds.  The patient tolerated the procedure well and was sent to recovery in
stable condition.  Intraoperative findings, postoperative care and course were
discussed with the patient's family and questions answered.


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## LindaEV (Mar 30, 2011)

unfortunately when you do a laparoscopic procedure with a scope through the site of the hernia, the hernia repair is considered inclusive of the closure. You should bill only the lap appe.


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