# Ventral hernia repair/fascial dehiscence repair



## lindacoder (Sep 6, 2012)

Patient is 10 days post op from small bowel resection and presents for ventral hernia/fascial dehiscence repair with AlloMax mesh and wound vac placement. 

Patient placed in supine position. The abdomen was prepped and draped in the normal sterile fashion. The patient was found to have very poorquality fascia. There was a wide defect  in the midline wound. These combination of factors did not allow a primary closure of the fascia. Given the risk of contamination and subsequent prosthetic mesh infection, I elected to proceed with  biologic mesh. The fascial sites were cleared for at least 5 cm circumferentially. The patient also had a fascial repair site to the right upper abdomen at the area of the previous enterocutaneous fistula. This tissue was found to be very friable and thus I elected to place an underlay piece of mesh to this as well. Two pieces of 10 x 15 AlloMax mesh were then chosen. These were quilted together to make on piece. This was able to completely fill the defect in an underlay position with excellent overlap of tissue back to healthy fascia, including the previous enterocutaneous fistula fascial site. #1 non-looped PDS was placed to the perimeter of the AlloMax circumferentially. Stab incisions were then made to the skin and the suture passer was then used to bring the PDS in a transfascial fashion circumferentially. This resulted in excellent coverage of the underlay mesh with at least 3 cm circumferentially. There was good hemostasis to the hernia repair site. Adaptic was placed just ove the fascia and a black Wound-Vac sponge placed through both sites purging the two defects. This was found to hold in an excelllent field. Steri-strips there then placed through the transfascial sites. Dry dressing was then applied. 

Not sure about using 49560 and 49568 or just 13160.  The procedure took approximately 2 hours so I don't feel like 13160 is enough.  Any ideas would be appreciate. 

Thanks


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## theresadickson (Oct 21, 2014)

*curious what you coded?*

I have a similar coding issue.  Can you tell me what you ended up doing and how you were paid?  Thanks!


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## cynthiabrown (Oct 23, 2014)

look at 49900...........


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