ddasilva5610
New
Hello,
Our office is wondering how everyone is coding for a laparoscopic hernia repair with abdominal wall reconstruction with bilateral rectus fascia flaps (i.e. flap 15734 open code)?
We have tried to use the unlisted code 49659 and equaling it to the hernia CPT and 15734 codes and they deny stating, "to use more specific codes." We have also tried to bill out the hernia CPT with an unlisted 49659 for the abdominal wall reconstruction with bilateral rectus fascia flaps. And this denies due to using an unlisted CPT from the same area.
Here is an example OP note:
Patient was taken to the OR and was placed in the supine position. IV antibiotics were given and general anesthesia induced. The Foley catheter was inserted and the abdomen was prepped and draped in the usual sterile fashion. We accessed the abdomen in the left subcostal area just lateral to the linea semilunaris muscle. We used a 5 mm trocar and the used a 0 degree 5 mm scope.
We were able to access the retrorectus space after we got through the anterior rectus sheath and rectus muscle on the left side. We then bluntly dissected the tips of the space and developed enough pocket in order to place two robotic trocars, 8 mm each, on the left side. We then upsized the same trocar into an 8 mm Da Vinci trocar.
The XI robot was docked and we started my dissection by releasing the posterior rectus muscle fascia creating a myofascial flap on the left side all the way medially to the linea alba. We then incised the linea alba vertically in the supraumbilical area and we were able to reduce the fat from the falciform ligament in order to stay in the extraperitoneal plane. We then identified the medial edge of the contro-lateral rectus muscle and we incised the posterior rectus fascia to create another flap, we developed the space posterior to the rectus muscle on the right side. We then worked our way down and we were able to encounter the hernias that measured 3x3 cm, 3x2 cm, 1 x 1 cm, in size; they were completely reduced, and we continued our dissection distally below the arcuate line. The surgical field was found to be completely dry, and we felt that we had enough space to overlap the mesh with at least 5 cm. After we completely released the posterior components to the linea semilunaris on both sides, we focused on the hernia repair and used 0 V-Loc sutures in order to close the hernias and we also used the same suture in order to approximate the diastasis above the umbilicus. We then placed a 30 x 20 cm polypropylene Parietene mesh.
The mesh was found to be covering the entire dissected area.
A TAP block was performed with 0.25% Marcaine under direct visualization in a multi quadrant fashion.
All trocars were then removed under direct vision after hemostasis was confirmed, and all skin incisions were closed with 4-0 Monocryl sutures. Dermabond was applied. The patient was extubated and transferred to the Post-Anesthesia Care Unit in stable condition. The needle, sponge and instrument counts were correct x 3.
Thank you in advance for any help
Our office is wondering how everyone is coding for a laparoscopic hernia repair with abdominal wall reconstruction with bilateral rectus fascia flaps (i.e. flap 15734 open code)?
We have tried to use the unlisted code 49659 and equaling it to the hernia CPT and 15734 codes and they deny stating, "to use more specific codes." We have also tried to bill out the hernia CPT with an unlisted 49659 for the abdominal wall reconstruction with bilateral rectus fascia flaps. And this denies due to using an unlisted CPT from the same area.
Here is an example OP note:
Patient was taken to the OR and was placed in the supine position. IV antibiotics were given and general anesthesia induced. The Foley catheter was inserted and the abdomen was prepped and draped in the usual sterile fashion. We accessed the abdomen in the left subcostal area just lateral to the linea semilunaris muscle. We used a 5 mm trocar and the used a 0 degree 5 mm scope.
We were able to access the retrorectus space after we got through the anterior rectus sheath and rectus muscle on the left side. We then bluntly dissected the tips of the space and developed enough pocket in order to place two robotic trocars, 8 mm each, on the left side. We then upsized the same trocar into an 8 mm Da Vinci trocar.
The XI robot was docked and we started my dissection by releasing the posterior rectus muscle fascia creating a myofascial flap on the left side all the way medially to the linea alba. We then incised the linea alba vertically in the supraumbilical area and we were able to reduce the fat from the falciform ligament in order to stay in the extraperitoneal plane. We then identified the medial edge of the contro-lateral rectus muscle and we incised the posterior rectus fascia to create another flap, we developed the space posterior to the rectus muscle on the right side. We then worked our way down and we were able to encounter the hernias that measured 3x3 cm, 3x2 cm, 1 x 1 cm, in size; they were completely reduced, and we continued our dissection distally below the arcuate line. The surgical field was found to be completely dry, and we felt that we had enough space to overlap the mesh with at least 5 cm. After we completely released the posterior components to the linea semilunaris on both sides, we focused on the hernia repair and used 0 V-Loc sutures in order to close the hernias and we also used the same suture in order to approximate the diastasis above the umbilicus. We then placed a 30 x 20 cm polypropylene Parietene mesh.
The mesh was found to be covering the entire dissected area.
A TAP block was performed with 0.25% Marcaine under direct visualization in a multi quadrant fashion.
All trocars were then removed under direct vision after hemostasis was confirmed, and all skin incisions were closed with 4-0 Monocryl sutures. Dermabond was applied. The patient was extubated and transferred to the Post-Anesthesia Care Unit in stable condition. The needle, sponge and instrument counts were correct x 3.
Thank you in advance for any help