mmfaust
New
I'm trying to figure out if coding CPT 49505 is appropriate for this repair of the inguinal floor with no hernia found. Maybe using modifier 52 since there was no hernia? Any help would be greatly appreciated!
Pre-procedure diagnosis:: Right inguinal pain
Post procedure diagnosis:: same (right inguinal floor weakness)
Procedure performed: Right inguinal hernia repair
Operative/procedure details:
After explaining the risks benefits alternatives of the procedure to the patient. Consent form was signed and the patient was transferred from the preoperative area to the operating room and placed on the table in supine position. Timeout was performed. Anesthesia was administered per the anesthesia department. Patient was then prepped and draped in the normal sterile fashion. The right inguinal area was then anesthetized with quarter percent Marcaine. Landmarks were identified and #15 blade scalpel was used to make a curvilinear incision. Dissection was carried down through the subcutaneous tissue with use of Bovie electrocautery. External oblique fascia was identified and incised with a #15 blade scalpel. The external oblique fascia was then opened widely with Metzenbaum scissors and a pushing fashion. The cord was then bluntly dissected free from the surrounding tissues. A Penrose drain was placed posterior to aid in retraction. The cord was then inspected. The cord is normal size there is no signs of an indirect hernia. The direct space was then inspected. The floor was noted to be weak. A patch was then obtained and sutured to the pubic tuberosity with 0 Vicryl in a simple interrupted fashion. A second 0 Vicryl was then run along the shelving portion of Poupart’s ligament. A third of Vicryl was then run along the aponeurosis of transversalis. The leaflets were then secured with 0 Vicryl in a simple interrupted fashion superiorly and laterally to the cord. The mesh was inspected and noted to be tension-free there were no signs of bleeding. The wound was then irrigated out with copious amounts normal saline. External oblique fascia was closed with 3-0 Vicryl in a running fashion. Subcutaneous tissues were irrigated out copiously with normal saline. Skin was then closed with a 4-0 Monocryl in a running subcuticular fashion. Sponge instrument and needle counts were correct. Steri-Strips and sterilie dressings were applied. I was present for the entire case. Assistant was present to provide exposure and retraction throughout the case.
Pre-procedure diagnosis:: Right inguinal pain
Post procedure diagnosis:: same (right inguinal floor weakness)
Procedure performed: Right inguinal hernia repair
Operative/procedure details:
After explaining the risks benefits alternatives of the procedure to the patient. Consent form was signed and the patient was transferred from the preoperative area to the operating room and placed on the table in supine position. Timeout was performed. Anesthesia was administered per the anesthesia department. Patient was then prepped and draped in the normal sterile fashion. The right inguinal area was then anesthetized with quarter percent Marcaine. Landmarks were identified and #15 blade scalpel was used to make a curvilinear incision. Dissection was carried down through the subcutaneous tissue with use of Bovie electrocautery. External oblique fascia was identified and incised with a #15 blade scalpel. The external oblique fascia was then opened widely with Metzenbaum scissors and a pushing fashion. The cord was then bluntly dissected free from the surrounding tissues. A Penrose drain was placed posterior to aid in retraction. The cord was then inspected. The cord is normal size there is no signs of an indirect hernia. The direct space was then inspected. The floor was noted to be weak. A patch was then obtained and sutured to the pubic tuberosity with 0 Vicryl in a simple interrupted fashion. A second 0 Vicryl was then run along the shelving portion of Poupart’s ligament. A third of Vicryl was then run along the aponeurosis of transversalis. The leaflets were then secured with 0 Vicryl in a simple interrupted fashion superiorly and laterally to the cord. The mesh was inspected and noted to be tension-free there were no signs of bleeding. The wound was then irrigated out with copious amounts normal saline. External oblique fascia was closed with 3-0 Vicryl in a running fashion. Subcutaneous tissues were irrigated out copiously with normal saline. Skin was then closed with a 4-0 Monocryl in a running subcuticular fashion. Sponge instrument and needle counts were correct. Steri-Strips and sterilie dressings were applied. I was present for the entire case. Assistant was present to provide exposure and retraction throughout the case.