donna3679
Contributor
One of my surgeons are starting to do alot of these: Exploratory laparotomy, extensive lysis of adhesions greater than 1 & 1/2 hours, explantation of prior abdominal mesh, placement of retrorectus abdominal mesh 6 inches x 8 inches.
dissecting the adhesions off the anterior abdominal wall. This was done until the anterior abdominal wall was freed from multiple adhesions small bowel and colon. Next the small bowel was identified ligament of Treitz and prolonged complex lysis of adhesions occurred until the terminal ileum. Continued complex abdominal wall adhesions again to the terminal ileum. The ascending transverse and descending colon are also free of adhesions. Once fully freed the abdomen was then thoroughly irrigated. A decision was made to explant the previously placed underlay mesh. This was taken from the underside of the abdominal wall fascia with combination of electrocautery and Metzenbaum scissors. Once removed the abdomen was then again thoroughly irrigated. A plane was made in the posterior rectus fascia bilaterally. The posterior rectus fascia was then approximated with running 2-0 PDS suture. The phasic's 8 inch x 6 inch mesh was then placed above the posterior rectus fascia this was secured at cardinal points.
I was told to use 20680 for removal of mesh not infected, not sure about that. Also, if I use 15777, implantation of biologic mesh for reinforcement of trunk, its an add on code with no primary surgery code. Am I looking at this all wrong??? PLEASE any one can help with this????
dissecting the adhesions off the anterior abdominal wall. This was done until the anterior abdominal wall was freed from multiple adhesions small bowel and colon. Next the small bowel was identified ligament of Treitz and prolonged complex lysis of adhesions occurred until the terminal ileum. Continued complex abdominal wall adhesions again to the terminal ileum. The ascending transverse and descending colon are also free of adhesions. Once fully freed the abdomen was then thoroughly irrigated. A decision was made to explant the previously placed underlay mesh. This was taken from the underside of the abdominal wall fascia with combination of electrocautery and Metzenbaum scissors. Once removed the abdomen was then again thoroughly irrigated. A plane was made in the posterior rectus fascia bilaterally. The posterior rectus fascia was then approximated with running 2-0 PDS suture. The phasic's 8 inch x 6 inch mesh was then placed above the posterior rectus fascia this was secured at cardinal points.
I was told to use 20680 for removal of mesh not infected, not sure about that. Also, if I use 15777, implantation of biologic mesh for reinforcement of trunk, its an add on code with no primary surgery code. Am I looking at this all wrong??? PLEASE any one can help with this????