# Multiple Ventral Hernias



## bennieyoung (Jan 8, 2009)

I'm a fairly new coder and my surgeon did a Laparoscopic ventral hernia repair with multiple hernia defects on a patient and I'm unsure how to code it.  He used a 30x20 cm mesh to cover the entire anterior abdominal wall with having at least 4 separate large defects.  I would appreciate any help with this.  Thanks!


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## FTessaBartels (Jan 8, 2009)

*Please post the note*

It sounds as though there were multiple defects, but only ONE repair?
I think we need to see the scrubbed op note to give you accurate guidance.

F Tessa Bartels, CPC, CEMC


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## bennieyoung (Jan 9, 2009)

A cutdown was made in the left upper quadrant.  Dissection was carried down to the fascia.  The rectus muscles were divided.  The posterior sheath was incised and a 5mm trocar was introduced.  Pneumoperitoneum was established.  Additional trocars were placed under direct vision.  Adhesions were then extensively taken down exposing multiple anterior abdominal wall defects.  It was elected to proceed with large dual sided mesh that had stay sutures placed in each corner.  The mesh was rolled up and introduced into the abdominal cavity.  Short, small incisions were made laterally and using a suture passer, the stay sutures were brought up into the anterior abdominal wall and tied, securing the mesh up to the anterior abdominal wall in all 4 quadrants.  With that secured, the mesh was then tacked around the periphery of all the defects securing it in multiple places.  This was done around the entire circumference of this large mesh.  At this inferior aspect of the mesh, there was still a small area that appeared to be close to the edge.  An additional piece of mesh was introduced and again secured around the very inferior portion of the mesh.  Hemostais appeared to be adequate.  the omentum was brought down to cover up the mesh.  The distal portion of the omentum was tacked down over the end of the mesh at the inferior aspect of the wounds.


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## magnolia1 (Jan 9, 2009)

I think this would be 49652 once.


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## aguelfi (Jan 9, 2009)

I agree w/ only one repair.


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## bennieyoung (Jan 9, 2009)

Thank you so much for your help!  This was the way I had planned to code this but then my doc insisted that it was seperate hernia's and much more work and he didn't feel that charging for just the one repair would cover it.  How do you handle this sort of thing with your docs when they don't agree with how you do this?  

Bennie Young, CPC


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## FTessaBartels (Jan 9, 2009)

*22 modifier if significantly more work*

I don't think 49652 will work because that is for a *laparoscopic *repair, and if I'm reading the report correctly, this was an open procedure. 

If it was open you should code 49560 and 49568. (You add the mesh implantation to the hernia code for open procedures.)

If the doctor *documents that the procedure required significantly more work *then you could append a -22 modifier and increase the fee (we usually increase by 25%). 

F Tessa Bartels, CPC, CEMC


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## magnolia1 (Jan 9, 2009)

I went with 49652 because of the trocar placement and establishment of pneumoperitoneum.


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## wmiller (Jan 29, 2009)

What if the op report indicates there are 4 separate hernias repaired with a total of 2 pieces of mesh.  Would you then code 2 hernia repair codes?  All of this is done through the same laparoscop incisions.


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