# inguinal and umbilical hernia repair



## Miagirl78 (Nov 10, 2010)

i have a case with an inguinal and umbilical hernia repair. How do you code this if after exploring, there was no umbilical hernia found??

so far i have
49505 for the inguinal hernia
but I am not sure which cpt to use for umbilical exploration/ hernia repair (there was no hernia)


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## FTessaBartels (Nov 10, 2010)

*Please post the operative note*

You will need to post the operative note to get an accurate response. Too many possible scenarios / options.

F Tessa Bartels, CPC, CEMC


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## Miagirl78 (Nov 10, 2010)

here is a copy of the report
thank you for any help you are able to give me!


PREOP DIAGNOSIS:  Right inguinal and umbilical hernia.

POSTOP DIAGNOSIS:  Right inguinal hernia.

PROCEDURE DONE:  Right inguinal hernia repair and umbilical exploration.

COMPLICATIONS:  None.

FINDINGS:  Small fatty right inguinal hernia and no evidence of umbilical hernia.

DESCRIPTION OF PROCEDURE:  After induction of general anesthesia, time-out was conducted, 2 g of Ancef was given.  The correct operative sites were noted as marked.  The abdomen and lower suprapubic area were shaved, prepped, and draped sterilely including an Ioban drape.  Under local anesthesia, right inguinal incision was made, carried down to the abdominal wall.  What appeared to be the external oblique over the inguinal canal was opened but this was found to be the anterior rectus sheath.  With further retraction, slight more Trendelenburg, the inguinal ligament was followed down to the groin and opened this time, entering the inguinal canal.  The ilioinguinal nerve was separated.  The round ligament and sac were dissected free, clamped and tied.  A small fatty protrusion and the remainder of the sac were tucked into the internal ring, held in place with a small ULTRAPRO plug.  The leaflets were placed in the preperitoneal space, the plug was sutured circumferentially to the edge of the inguinal ligament and the internal ring as well as the inguinal floor.  An onlay patch ULTRAPRO mesh was then anchored to the pubic tubercle, shelving edge of the inguinal ligament incorporating the previous plug with a running 2-0 PDS suture.  A slit was cut to allow the ilioinguinal nerve to lie in place and then was sutured with deep bites to the internal oblique.  The tails were trimmed and tacked together and it was entirely placed under the external oblique, which was closed with a 2-0 PDS suture.  The anterior rectus sheath was re-closed with a running 0 PDS suture.  The wound irrigated and locally infiltrated.  Scarpa's closed with PDS and skin with Monocryl.  A transverse subumbilical incision was made, carried down to the fascia.  The umbilical ligament was completely taken down.  The entire anterior fascia was explored, finding it quite lax but no evidence of herniation.  The previous repair where the Prolene sutures were found was opened.  The finger placed in the preperitoneal space again to the depth of the index finger circumferentially, no defects were found.  The opening was re-closed with 0 PDS suture.  The umbilicus tacked down, the wound irrigated, locally infiltrated, and was closed with Monocryl, Steri-Strips, and sterile dressing.  The patient tolerated the procedure well.

SPECIMEN:  Right inguinal hernia sac.


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## Lujanwj (Nov 10, 2010)

I'd try: 49505, 49585-52-51.  -52 it because your DX is going to show med nec. for the attempt at a repair.  Not to mention there isn't an ab explore code.


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## Miagirl78 (Nov 12, 2010)

thank you!! that is what i thought in the beginning, but wanted another opinion


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