Hi list,
I am needing some input please on how others would code. I have 15002? 13160? 49585?
TIA,
Melissa Bedford,CCS,CPC
PREOPERATIVE DIAGNOSIS(ES):
1. Intense abdominal wall scar.
2. Necrotic umbilicus.
3. Umbilical hernia.
POSTOPERATIVE DIAGNOSIS(ES):
1. Intense abdominal wall scar.
2. Necrotic umbilicus.
3. Umbilical hernia.
PROCEDURES:
1. Abdominal wall scar excision to include hypertrophic
scarring areas.
2. Excision of umbilicus down to level of fascia 3 x 3 x 4.
3. Repair of umbilical hernia without mesh.
ANESTHESIA:
GETA.
ESTIMATED BLOOD LOSS:
Minimal.
IV FLUIDS:
800.
URINE OUTPUT:
Not recorded.
SPECIMENS TO LAB:
Include,
1. Abdominal wall scar.
2. Umbilicus and stalk.
INDICATIONS FOR OPERATION:
The patient is a 74-year-old female who underwent a
paraesophageal hernia repair and splenectomy and at the same time
was diagnosed with amyloid disease based on her splenectomy
results. She then underwent an incisional hernia repair with
mesh. During the entire time of her healing from her original
operation, she had problems at her umbilical port site. She had
had a previous abdominoplasty in the past and her amyloid disease
does not heal well. Eventually, her umbilicus necrosed and after
multiple attempts at a variety of wound care options, she has
decided to have it excised. She would also like to have her scar
excised as well, and there is a large hypertrophic scar from a
hand port site, which was the extraction point for the spleen.
We discussed the risks and benefits of surgery, and she agreed to
proceed.
PROCEDURE IN DETAIL:
The patient was taken to the operating room, placed supine on the
operating table, and after adequate general endotracheal
anesthesia was given, she was prepped and draped in usual
fashion. The upper midline abdominal wall scar was excised
first. This was done all with sharp dissection and then closed
using a 4-0 Monocryl. Attention was then turned to the
umbilicus, and this was cut out in its entirety, with also using
sharp dissection only to maintain the vascular supply. This was
taken all the way down to the level of fascia where there was a
noted umbilical hernia. The stalk was amputated and sent to
Pathology. The umbilical hernia was repaired with a #1 Tycron in
a figure-of-eight fashion. The wound was irrigated liberally.
The soft tissues and deep tissues were closed using 3-0 Vicryl in
an interrupted fashion. Then, the skin was closed using 4-0
Monocryl in a running fashion, and then all wounds were protected
with Dermabond. The patient tolerated the procedure well, was
extubated at the end of the case, was taken to PACU
I am needing some input please on how others would code. I have 15002? 13160? 49585?
TIA,
Melissa Bedford,CCS,CPC
PREOPERATIVE DIAGNOSIS(ES):
1. Intense abdominal wall scar.
2. Necrotic umbilicus.
3. Umbilical hernia.
POSTOPERATIVE DIAGNOSIS(ES):
1. Intense abdominal wall scar.
2. Necrotic umbilicus.
3. Umbilical hernia.
PROCEDURES:
1. Abdominal wall scar excision to include hypertrophic
scarring areas.
2. Excision of umbilicus down to level of fascia 3 x 3 x 4.
3. Repair of umbilical hernia without mesh.
ANESTHESIA:
GETA.
ESTIMATED BLOOD LOSS:
Minimal.
IV FLUIDS:
800.
URINE OUTPUT:
Not recorded.
SPECIMENS TO LAB:
Include,
1. Abdominal wall scar.
2. Umbilicus and stalk.
INDICATIONS FOR OPERATION:
The patient is a 74-year-old female who underwent a
paraesophageal hernia repair and splenectomy and at the same time
was diagnosed with amyloid disease based on her splenectomy
results. She then underwent an incisional hernia repair with
mesh. During the entire time of her healing from her original
operation, she had problems at her umbilical port site. She had
had a previous abdominoplasty in the past and her amyloid disease
does not heal well. Eventually, her umbilicus necrosed and after
multiple attempts at a variety of wound care options, she has
decided to have it excised. She would also like to have her scar
excised as well, and there is a large hypertrophic scar from a
hand port site, which was the extraction point for the spleen.
We discussed the risks and benefits of surgery, and she agreed to
proceed.
PROCEDURE IN DETAIL:
The patient was taken to the operating room, placed supine on the
operating table, and after adequate general endotracheal
anesthesia was given, she was prepped and draped in usual
fashion. The upper midline abdominal wall scar was excised
first. This was done all with sharp dissection and then closed
using a 4-0 Monocryl. Attention was then turned to the
umbilicus, and this was cut out in its entirety, with also using
sharp dissection only to maintain the vascular supply. This was
taken all the way down to the level of fascia where there was a
noted umbilical hernia. The stalk was amputated and sent to
Pathology. The umbilical hernia was repaired with a #1 Tycron in
a figure-of-eight fashion. The wound was irrigated liberally.
The soft tissues and deep tissues were closed using 3-0 Vicryl in
an interrupted fashion. Then, the skin was closed using 4-0
Monocryl in a running fashion, and then all wounds were protected
with Dermabond. The patient tolerated the procedure well, was
extubated at the end of the case, was taken to PACU