Brittany3
New
Can anyone help with the below case: I question the excision of the excess sac and am wondering what the proper code selection is.
PREOPERATIVE DIAGNOSIS: Symptomatic left inguinal hernia.
POSTOPERATIVE DIAGNOSIS: Symptomatic left inguinal hernia.
PROCEDURE: Left inguinal hernia repair with Bard soft mesh.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and a time-out was performed. Anesthesia was achieved with IV sedation plus local infiltration of 0.5% Marcaine with epinephrine. A left inguinal incision was made and the dissection carried down to the external oblique aponeurosis. Further local was infiltrated below the external oblique. An incision was made and carried through the external inguinal ring. The cord structures were then mobilized. This was difficult because the patient had an extremely large sac. This, however, was dissected from the inguinal floor intact. The cord structures and the sac were then retracted with a Penrose. The sac was then dissected free from the cord structures. Care was taken to avoid injury to the vas and vessels and to the contained bowel in the sac. Eventually, the sac was dissected up through the internal ring. At this point, a high ligation of the sac was accomplished. The excess sac was excised and the stump was allowed to retract above the internal ring. The attenuated transversalis fascia was then closed with a running 3-0 Vicryl. An onlay patch of Bard soft mesh was cut to appropriate size and sutured in place with 2-0 Nurolon. It was split laterally to accommodate the cord and the mesh then sutured together lateral encompassing the cord. Hemostasis was adequate. The external oblique was then closed with a running 3-0 Vicryl. The subcutaneous was closed with 4-0 Vicryl and the skin with an intracuticular 4-0 Vicryl. The patient tolerated the procedure well and was returned to the recovery room in stable condition.
PREOPERATIVE DIAGNOSIS: Symptomatic left inguinal hernia.
POSTOPERATIVE DIAGNOSIS: Symptomatic left inguinal hernia.
PROCEDURE: Left inguinal hernia repair with Bard soft mesh.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and a time-out was performed. Anesthesia was achieved with IV sedation plus local infiltration of 0.5% Marcaine with epinephrine. A left inguinal incision was made and the dissection carried down to the external oblique aponeurosis. Further local was infiltrated below the external oblique. An incision was made and carried through the external inguinal ring. The cord structures were then mobilized. This was difficult because the patient had an extremely large sac. This, however, was dissected from the inguinal floor intact. The cord structures and the sac were then retracted with a Penrose. The sac was then dissected free from the cord structures. Care was taken to avoid injury to the vas and vessels and to the contained bowel in the sac. Eventually, the sac was dissected up through the internal ring. At this point, a high ligation of the sac was accomplished. The excess sac was excised and the stump was allowed to retract above the internal ring. The attenuated transversalis fascia was then closed with a running 3-0 Vicryl. An onlay patch of Bard soft mesh was cut to appropriate size and sutured in place with 2-0 Nurolon. It was split laterally to accommodate the cord and the mesh then sutured together lateral encompassing the cord. Hemostasis was adequate. The external oblique was then closed with a running 3-0 Vicryl. The subcutaneous was closed with 4-0 Vicryl and the skin with an intracuticular 4-0 Vicryl. The patient tolerated the procedure well and was returned to the recovery room in stable condition.