Wiki parastomal hernia of ileal conduit

[hsmith67]

Debate on the correct coding of the following operative report. Assistance is greatly appreciated.

"The parastomal hernia was located somewhat slightly superior and lateral to the conduit. We make an incision after anesthetizing the area about the 9 o'clock position outside of the ostomy bag. The subcutaneous tissue was then separated away. The hernia defect is seen the hernia sac is opened we entered the abdomen lysis of adhesions were taken down from the hernia sac and from the anterior abdominal wall from the 12:00 to 6 o'clock position. Were able to see the ileoconduit and palpate the red rubber tube within the ileal conduit. Once we felt comfortable we had identified a complete portion of the hernia sac in the ileoconduit. The fascial defect measured about 4 and half centimeters in length in a horizontal fashion.
I then reapproximate the fascia in a horizontal fashion using 0 Ethibond sutures we used a total of 5. There is no compromise or stenosis of the ileoconduit. After this was done we closed the deep layer with a 3-0 Vicryl and the skin is reapproximated with interrupted 3-0 nylon. Sterile bandages placed on the incision. We then placed the ostomy appliance in the typical fashion."

Thanks for any coding guidance!
Hunter Smith, CPC

 

[nickelclaw]

Debate on the correct coding of the following operative report. Assistance is greatly appreciated.

"The parastomal hernia was located somewhat slightly superior and lateral to the conduit. We make an incision after anesthetizing the area about the 9 o'clock position outside of the ostomy bag. The subcutaneous tissue was then separated away. The hernia defect is seen the hernia sac is opened we entered the abdomen lysis of adhesions were taken down from the hernia sac and from the anterior abdominal wall from the 12:00 to 6 o'clock position. Were able to see the ileoconduit and palpate the red rubber tube within the ileal conduit. Once we felt comfortable we had identified a complete portion of the hernia sac in the ileoconduit. The fascial defect measured about 4 and half centimeters in length in a horizontal fashion.
I then reapproximate the fascia in a horizontal fashion using 0 Ethibond sutures we used a total of 5. There is no compromise or stenosis of the ileoconduit. After this was done we closed the deep layer with a 3-0 Vicryl and the skin is reapproximated with interrupted 3-0 nylon. Sterile bandages placed on the incision. We then placed the ostomy appliance in the typical fashion."

Thanks for any coding guidance!
Hunter Smith, CPC

Hello I would go with 49561 below is CDR description of procedure and since the hernia sac was opened and in the ileoconduit this is incarcerated to me.
49561

The physician repairs an incarcerated incisional hernia. The physician makes an incision over the hernia. Dissection is continued through scar tissue and the hernia sac is identified and dissected from surrounding structures. The fascial defect is identified circumferentially. The hernia sac is opened and the contents of the hernia sac are examined. If the contents of the hernia sac are viable the hernia is reduced and the hernia sac is closed and may be resected. The hernia defect is closed with sutures. The incision is closed.

 

[hsmith67]

Hello I would go with 49561 below is CDR description of procedure and since the hernia sac was opened and in the ileoconduit this is incarcerated to me.
49561

The physician repairs an incarcerated incisional hernia. The physician makes an incision over the hernia. Dissection is continued through scar tissue and the hernia sac is identified and dissected from surrounding structures. The fascial defect is identified circumferentially. The hernia sac is opened and the contents of the hernia sac are examined. If the contents of the hernia sac are viable the hernia is reduced and the hernia sac is closed and may be resected. The hernia defect is closed with sutures. The incision is closed.

Thanks. What are your thoughts on 50728 - Revision of urinary-cutaneous anastomosis (any type urostomy); with repair of fascial defect and hernia?

 

[nickelclaw]

for this procedure? no I would base on the hernia. below doesn't sound like what was done to me. I read it was abdominal incarcerated in the ileoconduit. If unclear you can query or ask the provider.
50727-50728

The physician revises any surgical opening (anastomosis) between the skin and ureter, bladder, or colon segment. The physician removes the sutures securing the anastomosis to the skin and revises the anastomosis. The physician may make a midline incision in the skin of the abdomen to access the urinary tract. In 50728, the physician repairs a defect in surrounding fibrous membranes (fascia), and/or a rupture (hernia) in ureteral tissues.