I am having trouble with this the physician wants to bill 49651 and am torn between it and 49659 any help would be great as I haven't coded obturator hernia often.
Pre-op Diagnosis: Incarc Obturator Hernia
Procedure: Procedure(s):
Laparoscopic Obturator Hernia Repair incarcerated
Findings: The SB had reduced. There was some edema in the incarc hernia with some omentum. The SB was pretty normal. There was a 1cm Obturator Hernia
Procedure Details: After sterile prep and drape, a timeout was performed. A midline supra-umb veres needle was placed and the saline drop test was passed. The abd was infilt with CO2 and a 5mm Port placed using 5 mm scope in visualizing lumen. There was no abd injury however the preperit was filled with CO2. This turned out to be beneficial as after I placed 2 more 5mm ports in RLQ I could easily see the preperitoneal space as it had already been dissected.. Once I confirmed the hernia location I entered the pre-perit by incising the peritoneum and reducing the fat out of the hernia along Coopers. I placed a small 3D Max mesh into the pre-perit space and tacked it with an absorbable tacker into the symphisis with a couple of tacks to coopers and the ant abd wall. I then closed the perit defect with absorbable tacks, completely covering the mesh. Everything was infilt with local and the gas was allowed to escape under direct vision. The pt tol well. The skin was closed with 4-0 Biosyn. The RLQ port which I upsized to a 10 was a tiny fascial defect so was left alone.
Pre-op Diagnosis: Incarc Obturator Hernia
Procedure: Procedure(s):
Laparoscopic Obturator Hernia Repair incarcerated
Findings: The SB had reduced. There was some edema in the incarc hernia with some omentum. The SB was pretty normal. There was a 1cm Obturator Hernia
Procedure Details: After sterile prep and drape, a timeout was performed. A midline supra-umb veres needle was placed and the saline drop test was passed. The abd was infilt with CO2 and a 5mm Port placed using 5 mm scope in visualizing lumen. There was no abd injury however the preperit was filled with CO2. This turned out to be beneficial as after I placed 2 more 5mm ports in RLQ I could easily see the preperitoneal space as it had already been dissected.. Once I confirmed the hernia location I entered the pre-perit by incising the peritoneum and reducing the fat out of the hernia along Coopers. I placed a small 3D Max mesh into the pre-perit space and tacked it with an absorbable tacker into the symphisis with a couple of tacks to coopers and the ant abd wall. I then closed the perit defect with absorbable tacks, completely covering the mesh. Everything was infilt with local and the gas was allowed to escape under direct vision. The pt tol well. The skin was closed with 4-0 Biosyn. The RLQ port which I upsized to a 10 was a tiny fascial defect so was left alone.