AT2728
Expert
Thoughts on the following: I feel this clearly would be appropriate to add modifier 22 to 49525 since he documents complications encountered and time extended by more than 50%.
Even with the defect identified from inside the sac, the hernia was not reducible because of significant thickened fatty infiltration of the mesentery and the sigmoid itself. The sigmoid was healthy and without obstruction. The sigmoid did form a portion of the sac with a sliding hernia noted. The sac was subsequently closed and dissection carried down superiorly down to the origin of the sac and the edge of the hernia defect was identified. The sac was dissected free from the edge of the hernia defect. Scar was taken down and the conjoined tendon and muscle was divided superior medially for approximately 1.5 cm to 2.0 cm to help open up the defect for reduction. The underlying transversalis fascia was also opened up under direct dissection with care taken to stay out of the peritoneal cavity. With the subsequent direct defect opened up in this fashion, the hernia sac was easily reducible. He also documents that due the massive size, etc extended the procedure time ----[I]The first hour and 15 minutes to an hour and 30 minutes of a 2 hour case involved freeing up the hernia sac with careful dissection, taking down scar, extending the defect and maintaining
reduction.[/I]
Even with the defect identified from inside the sac, the hernia was not reducible because of significant thickened fatty infiltration of the mesentery and the sigmoid itself. The sigmoid was healthy and without obstruction. The sigmoid did form a portion of the sac with a sliding hernia noted. The sac was subsequently closed and dissection carried down superiorly down to the origin of the sac and the edge of the hernia defect was identified. The sac was dissected free from the edge of the hernia defect. Scar was taken down and the conjoined tendon and muscle was divided superior medially for approximately 1.5 cm to 2.0 cm to help open up the defect for reduction. The underlying transversalis fascia was also opened up under direct dissection with care taken to stay out of the peritoneal cavity. With the subsequent direct defect opened up in this fashion, the hernia sac was easily reducible. He also documents that due the massive size, etc extended the procedure time ----[I]The first hour and 15 minutes to an hour and 30 minutes of a 2 hour case involved freeing up the hernia sac with careful dissection, taking down scar, extending the defect and maintaining
reduction.[/I]
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