# Hernia repair & q-pump insertion



## ksb0211 (Aug 2, 2012)

Okay.  I've recently come across an argument regarding how to code for this.  Of course, the inguinal hernia repair is 49505.  My question is, since the placement of the q-pump was also done, does anyone else bill that?  Op report attached.  One coder stated that we should be billing 49505 & 11981.

DIAGNOSIS
Large left indirect inguinal hernia.

OPERATION PERFORMED
Plug and patch repair.

DESCRIPTION OF PROCEDURE
The patient was brought to the operating room.  After attainment of sufficient general anesthesia, he was pretreated with antibiotics and prepped and draped in the usual sterile fashion.  About an 8 or 9 cm incision was made in the left groin extending from the left pubic tubercle over to the left anterior superior iliac crest.  The incision was carried down deep to the external oblique fascia which we opened in the direction of its fibers.  Ilioinguinal nerve was identified, reflected inferiorly and preserved.  Cord was then mobilized, it was a giant cord with a huge lipoma associated with it.  We reduced this back within the abdominal cavity, then used a large plug fixed it in place and then fixed that plug to the shelving edge with a non-_____ suture and also transverse abdominis aponeurosis.  We then placed an onlay mesh, fixing it to lacunar ligament medially, shelving edge inferiorly, transversus abdominis aponeurosis superiorly, then dovetailed it behind the cord bringing the nerve out with the cord.  Once that was done, we irrigated, and then closed the external oblique fascia with a running locking suture of 3-0 Vicryl, placed the On-Q pump into position underneath the fascia and then closed deep tissues with 3-0 Vicryl followed by running subcuticular suture of 4-0 Vicryl.  Sterile dressing was applied.  The patient tolerated the procedure quite well.


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## aqualady1969 (Aug 2, 2012)

I code general surgery and I use 37202 for the pain pump with dx of 338.18 and do get paid for it,, you will need to put a 59 modifier on the 37202


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## Lujanwj (Aug 2, 2012)

Not billable to CMS.  It's considered part of the Surgical Package for pain management.  For a private payer, check your policy and if billable use the unlisted to the body site (22999/49999) and 11981 for comparable.  It's not the same as 11981 but seems close in value - check with Dr.


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