# Help coding laparoscopic repair of parastomal hernia with mesh



## jbonjour (Feb 12, 2016)

From what I am finding, I should bill unlisted 50949 and like it to 50728.  The provider says it should be billed as unlisted 49659 and like it to 44346.  Any help would be greatly appreciated.  I have included a copy of the OP note. 

PREOPERATIVE DIAGNOSIS: Parastomal hernia 

POSTOPERATIVE DIAGNOSIS: same 

PROCEDURE: Laparoscopic repair of parastomal hernia with mesh

ANESTHESIA: General 

ESTIMATED BLOOD LOSS: Minimal 

DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed in a supine position. Anesthesia was induced and the urostomy was closed with a suture.* The abdomen was prepped and draped in the usual sterile fashion taking care to separate the urostomy with an extra isolation.. A Veress needle was placed in the left upper quadrant. After a normal saline drop test, the abdomen was insufflated with CO2. A 5mm trocar was placed in the left mid abdomen. The camera was placed and there was no evidence of injury from the Veress needle or the initial trocar insertion. Additional 5mm trocars were placed in the right and left side of the abdomen. 

There were relatively few adhesions within the abdominal cavity.* There was incarcerated omentum up within the parastomal hernia.* This was gently reduced using occasional sharp dissection and cautery for hemostasis.* The ileal conduit was separated from the surrounding defect and all adhesions were dissected.* The stapled end of the urostomy was densely adherent to the defect which made it quite difficult to free this from the side of the hernia defect.* This was freed and eventually resected with a laparoscopic stapler.* This was placed with an Endo Catch bag and discarded.* Once completely free and dissected, the stomal defect was measured at approximately 7 x 6 cm.* I fashioned a 15 cm round Gore-Tex dual mesh plus mesh for the hernia repair.* This provided well over 5 cm of overlap on all sides of the hernia defect once it had been placed inside the abdomen.* CVO Gore-Tex suture was placed at three quarters of the mesh.* And then 4 additional CVO Gore-Tex sutures were placed inferiorly in a railroad track fashion to allow passage of the ileal conduit.* The mesh was then placed intracorporeally.* This was then secured to the anterior abdominal wall using the suture passer device.* The mesh was then tacked along its perimeter using the pro-tack.* 4 additional CVO Gore-Tex sutures were placed around the perimeter of the mesh and equal distances.* Hemostasis was insured.* The 12 mm trocar fascial defect was closed with an 0 Vicryl suture.

The abdominal ports were removed under direct vision with good hemostasis. The abdomen was desufflated. Local anesthesia was administered to the wounds and they were closed with subcuticular 4-0 Monocryl suture, followed by Dermabond.* The suture at the urostomy site was cut and an appliance was applied.

The patient tolerated the procedure well.


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## syllingk (Feb 15, 2016)

I agree with you. It can't be the providers recommendation because those codes are for bowel.


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## syllingk (Feb 15, 2016)

not sure if you can use a hernia repair code. Could that fall under incisional hernia? I don't know. what does everyone else say? If it could you might look at the 49659. Those all include mesh. but I agree it sounds like the revision with the hernia defect repair. but done lap


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