bda23054
Networker
I could use some insight as to the correct coding for this one. I'm not sure if I'm right or wrong and just a little confused.
I am thinking 49561, 49568, 15734 (bilateral).
Here is the Operative Report:
The patient was brought to the Operating Room table and placed in the supine position. General endotracheal anesthesia was induced. The abdomen was prepped and draped in the usual sterile fashion. A left upper quadrant incision was made 5 mm in left upper quadrant. Visiport was inserted over flexible tip laparoscope into the peritoneal cavity. Abdomen was insufflated with carbon dioxide gas to a pressure of 15 mmHg. The patient tolerated insufflation well. The laparoscope was then reinserted. No injury from initial trocar placement was noted. The abdomen was explored. There was noted to be incarceration of omentum into a ventral defect. Second incision in the right lower quadrant was made 5 mm in size. Trocar was inserted under direct vision. The defect measured approximately 9 cm circular and was found above the previously placed umbilical mesh. This defect was judged too large to be closed primarily, so the area was marked of the hernia and a small incision was made over the hernia that encompassed the whole hernia, so a 9 cm incision was made. Pneumoperitoneum was lost and the fascia on all sides were grasped and using electrocautery, flaps were developed laterally.
This was carried all the way to the lateral rectus sheath which was incised and opened. This was done bilaterally, bilateral myofascial release and at this point the defect easily was approximated, as a matter of fact, with slight redundancy in the midline. A Parietex 9 cm PCO mesh was then prepared by placing two 2-0 Prolene sutures 180 degrees apart and placed within the peritoneal cavity. The defect was then closed primarily using multiple interrupted 0-Ethibond sutures and then the pneumoperitoneum was restarted and laparoscope was then reinserted. From this vantage point, the previously placed 2-0 Prolene were grasped under direct vision on an endoscopic suture passer and grasped to perform as a transfascial suture. Using a secure strap, the mesh was then fixated around the peritoneal cavity giving good overlay in all directions. At this point, the laparoscope was withdrawn. The abdomen was allowed to collapse and the midline incision was closed in multiple layers with 3-0 Vicryl and a JP drain was brought through a separate stab wound incision to control hemostasis issues above the fascia. The incision was closed with 3-0 and skin staples. Pressure dressing was applied. The patient tolerated the procedure well and was wheeled to the Post Anesthesia Care Unit in stable condition.
I am thinking 49561, 49568, 15734 (bilateral).
Here is the Operative Report:
The patient was brought to the Operating Room table and placed in the supine position. General endotracheal anesthesia was induced. The abdomen was prepped and draped in the usual sterile fashion. A left upper quadrant incision was made 5 mm in left upper quadrant. Visiport was inserted over flexible tip laparoscope into the peritoneal cavity. Abdomen was insufflated with carbon dioxide gas to a pressure of 15 mmHg. The patient tolerated insufflation well. The laparoscope was then reinserted. No injury from initial trocar placement was noted. The abdomen was explored. There was noted to be incarceration of omentum into a ventral defect. Second incision in the right lower quadrant was made 5 mm in size. Trocar was inserted under direct vision. The defect measured approximately 9 cm circular and was found above the previously placed umbilical mesh. This defect was judged too large to be closed primarily, so the area was marked of the hernia and a small incision was made over the hernia that encompassed the whole hernia, so a 9 cm incision was made. Pneumoperitoneum was lost and the fascia on all sides were grasped and using electrocautery, flaps were developed laterally.
This was carried all the way to the lateral rectus sheath which was incised and opened. This was done bilaterally, bilateral myofascial release and at this point the defect easily was approximated, as a matter of fact, with slight redundancy in the midline. A Parietex 9 cm PCO mesh was then prepared by placing two 2-0 Prolene sutures 180 degrees apart and placed within the peritoneal cavity. The defect was then closed primarily using multiple interrupted 0-Ethibond sutures and then the pneumoperitoneum was restarted and laparoscope was then reinserted. From this vantage point, the previously placed 2-0 Prolene were grasped under direct vision on an endoscopic suture passer and grasped to perform as a transfascial suture. Using a secure strap, the mesh was then fixated around the peritoneal cavity giving good overlay in all directions. At this point, the laparoscope was withdrawn. The abdomen was allowed to collapse and the midline incision was closed in multiple layers with 3-0 Vicryl and a JP drain was brought through a separate stab wound incision to control hemostasis issues above the fascia. The incision was closed with 3-0 and skin staples. Pressure dressing was applied. The patient tolerated the procedure well and was wheeled to the Post Anesthesia Care Unit in stable condition.