Hi. I'm having trouble deciding on what to code for this Op note. Two hernias were fixed laparoscopically and one was an open hernia. Can I code a lap with an open since it wasn't technically the same surgery? Do I do bilateral hernias? Not sure...
...The abdomen was prepped and draped. An infraumbilical incision was made. Subcutaneous fat was divided. The rectus fascia was incised to the right of the midline and in the retrorectus space. Spacemaker trocar was inserted and bluntly dissected down to the pubis symphysis. Spacemaker was insufflated bluntly dissecting the preperitoneal space. Pneumopreperitoneum was then obtained with carbon dioxide insufflation. Two 5mm lower midline ports were inserted. A right indirect hernia sac was identified and separated away from the cord structures widely enough to allow mesh placement. A left indirect inguinal hernia sac was identified and separated away from the cord structures as well. Additionally a moderate sized direct hernia defect was located on the left side medial to the inferior epigastric vessels. The right inferior epigastric vascular group was dissected away from the rectus muscle by the spacemaker and in order to facilitate mesh placement it was clipped and divided. At this point a large preformed bard 3d max light mesh was inserted centered over the left internal ring and then secured at the pubic symphysis and Cooper's ligament with a Pro Tacker. The mesh was examined circumferentially and no peritoneum extended up under the mesh. The right side mesh was then inserted, centered and tacked similarly examined around the edges and no peritoneum extended up under this either. Some venous oozing had pooled in the pelvis, the was suctioned dry and no further bleeding was noted. The pneumopreperitoneum was evacuated and ports were withdrawn.
Next, the umbilical dermis was incised and separated away from underlying umbilical hernia defect. The hernia sac was reduced through a 5-7mm size hernia defect in the fascia which was then closed primarily with interrupted 0 nurolon. The fascial defect was closed. The umbilicus dermis was tacked down...
Thoughts on this one?
...The abdomen was prepped and draped. An infraumbilical incision was made. Subcutaneous fat was divided. The rectus fascia was incised to the right of the midline and in the retrorectus space. Spacemaker trocar was inserted and bluntly dissected down to the pubis symphysis. Spacemaker was insufflated bluntly dissecting the preperitoneal space. Pneumopreperitoneum was then obtained with carbon dioxide insufflation. Two 5mm lower midline ports were inserted. A right indirect hernia sac was identified and separated away from the cord structures widely enough to allow mesh placement. A left indirect inguinal hernia sac was identified and separated away from the cord structures as well. Additionally a moderate sized direct hernia defect was located on the left side medial to the inferior epigastric vessels. The right inferior epigastric vascular group was dissected away from the rectus muscle by the spacemaker and in order to facilitate mesh placement it was clipped and divided. At this point a large preformed bard 3d max light mesh was inserted centered over the left internal ring and then secured at the pubic symphysis and Cooper's ligament with a Pro Tacker. The mesh was examined circumferentially and no peritoneum extended up under the mesh. The right side mesh was then inserted, centered and tacked similarly examined around the edges and no peritoneum extended up under this either. Some venous oozing had pooled in the pelvis, the was suctioned dry and no further bleeding was noted. The pneumopreperitoneum was evacuated and ports were withdrawn.
Next, the umbilical dermis was incised and separated away from underlying umbilical hernia defect. The hernia sac was reduced through a 5-7mm size hernia defect in the fascia which was then closed primarily with interrupted 0 nurolon. The fascial defect was closed. The umbilicus dermis was tacked down...
Thoughts on this one?