# Exploratory Lap, lysis adhesions / Hernia



## bill2doc (Mar 12, 2012)

Can someone please help with codes.  Not sure if Explor Lap or Hernia codes or both ??
Thank you !

PROCEDURES:  
1.  Exploratory laparotomy.
2.  Lysis of adhesions.
3.  Reduction.

PROCEDURE PERFORMED:  Repair of ventral hernia in the left lower quadrant in the 

DESCRIPTION OF PROCEDURE:  The abdomen was prepped and draped in standard fashion.  A lower midline incision was then made and carried through the subq tissues to reveal the fascia.  The fascia was then incised and the abdomen entered.  Of note, there is significant amount of adhesions in the pelvis and left lower quadrant, likely secondary to her previous pelvic procedures.  

The colon was able to be identified and it was able to be traced proximally and distally once the adhesions and left lower quadrant were lysed.  The colon was then allowed to be reduced out of the hernia which was then examined.  There was some scarring between the colon wall and the peritoneum that incorporated the hernia sac.  This tissue was then excised and passed off the field as specimen.  The hernia defect appeared to be just a 3 x 2 cm hole in the lateral left lower quadrant and did not appear to be either a typical speculated hernia nor involved with her previous incisions.  The hernia cavity appeared to track superiorly. 

Due to the significant number of adhesions, there were 3 small serosal tears that needed to be repaired using interrupted Lembert silk sutures.  The hernia defect was then repaired primarily using 0 Ethibond and an intraperitoneal composite 2-layer mesh was then placed over the repair and tacked to the abdominal wall circumferentially, again using 0 Ethibond.  The bowel was then reexamined and there were no other injuries noted.  The midline incision was then closed with a looped #1 PDS and the skin was closed with staples.


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## tcooper@tupelosurgery.com (Mar 12, 2012)

I would use 49560 and 49568 for the Mesh. You could add a 22 Modifier to the 49560 for the Adhesions if they were extensive and took an extensive amount of time. The Exploratory Lap and Lysis of Adhesions are bundled into the hernia code. Hope this helps.


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