# scrotal/inguinal hernia 49505 and 54640



## Elizabeth83 (Jul 11, 2013)

I'm uncertain if i could bill for a 54640 or if this is possibly an incarcerated hernia? 


The patient was taken to the operating room, placed
supine and was given general anesthesia.  The right side was prepped and
draped sterilely.  The area had been marked in the holding room and a
time-out taken.  A right lower quadrant hernia incision made.  Dissection
was carried down to the external oblique.  The external oblique was opened
through the ring.  A very large inguinal hernia was encountered.  This was
a scrotal hernia.  I was able to reduce the scrotal contents back into the
abdomen, and I was then able to dissect out a very large sac from the cord.
The sac was opened.  One could see the small bowel and the appendix at the
internal ring, and a high ligation was carefully performed and the sac
amputated.  The inguinal floor was extremely attenuated.  I placed a piece
of mesh on the inguinal floor and anchored it circumferentially using 0
Ethibond and the hernia stapler inferior to the inguinal ligament, superior
to the internal oblique, wrapping the tails of the mesh around the cord.
The mesh now was irrigated with antibiotic solution.  The area then was
infiltrated with 0.25% Marcaine with epinephrine.  The external oblique
then was closed with 2-0 Vicryl, Scarpa's fascia with 3-0 Vicryl and the
skin with a stapler.  A dressing was applied.  the testicle was pulled down
in the scrotum.  [/COLOR]The patient was taken to the recovery room stable.  The
sponge and needle counts were correct.


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## TWinsor (Jul 12, 2013)

this looks like just RIH repair to me (49505).  I don't see documentation of incarceration or orchiopexy.


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