codedog
True Blue
Wondering can I BILL A umbilectomy with a herina repair ? Thinking no but looking at this operative report seems like I can code for 2 herinas. What do you think, ?
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POSTOPERATIVE DIAGNOSIS: Abdominal wall hernia and umbilical hernia.
OPERATION: Repair of hernia with polypropylene mesh, umbilectomy and placement of a 19-French Blake drain.
PROCEDURE IN DETAIL:
After appropriate informed consent was signed, the patient was taken to the operating room, was transferred operating table, underwent general endotracheal anesthesia with successful endotracheal intubation. The abdomen was prepped and draped in normal fashion. The patient had been examined in the preoperative holding area. Preoperative antibiotics were given prior to skin incision. Time-out had been performed to identify correct patient and correct procedure, was prepped with DuraPrep solution. After waiting five minutes and prepped with DuraPrep solution, an incision was made 5 cm above the umbilicus, just around the umbilicus and down below the umbilicus. Dissection was carried down through the skin and subcutaneous tissue until we discovered the hernia sac. The hernia sac was gently opened. The hernia sac was excised. There was some incarcerated omentum and there was a bridge defect around 3 cm between this hernia and umbilical hernia. This was then opened to create one large hernia space and this hernia defect was around 5 x 8 cm. The fascial edges were cleared up all the way around. A piece of Parietex Composite mesh was sewn in, a 10 x 15 cm piece of mesh. With the appropriate side down on the bowel, it was sewn with #1 Ethibond interrupted. There was noted to be an excellent repair without evidence of tension. Umbilicus was noted not to be viable at this point and umbilectomy was performed. The fascia was then cleared off. The area was irrigated and noted to be again an excellent repair with no tension at all. Sutures were placed under direct vision. A 19-French Blake drain was left. The area was then closed with 3-0 Vicryl and the drain was sewn with 2-0 nylon and the skin was sewn with 2-0 nylon and staples.
THANKS
.
POSTOPERATIVE DIAGNOSIS: Abdominal wall hernia and umbilical hernia.
OPERATION: Repair of hernia with polypropylene mesh, umbilectomy and placement of a 19-French Blake drain.
PROCEDURE IN DETAIL:
After appropriate informed consent was signed, the patient was taken to the operating room, was transferred operating table, underwent general endotracheal anesthesia with successful endotracheal intubation. The abdomen was prepped and draped in normal fashion. The patient had been examined in the preoperative holding area. Preoperative antibiotics were given prior to skin incision. Time-out had been performed to identify correct patient and correct procedure, was prepped with DuraPrep solution. After waiting five minutes and prepped with DuraPrep solution, an incision was made 5 cm above the umbilicus, just around the umbilicus and down below the umbilicus. Dissection was carried down through the skin and subcutaneous tissue until we discovered the hernia sac. The hernia sac was gently opened. The hernia sac was excised. There was some incarcerated omentum and there was a bridge defect around 3 cm between this hernia and umbilical hernia. This was then opened to create one large hernia space and this hernia defect was around 5 x 8 cm. The fascial edges were cleared up all the way around. A piece of Parietex Composite mesh was sewn in, a 10 x 15 cm piece of mesh. With the appropriate side down on the bowel, it was sewn with #1 Ethibond interrupted. There was noted to be an excellent repair without evidence of tension. Umbilicus was noted not to be viable at this point and umbilectomy was performed. The fascia was then cleared off. The area was irrigated and noted to be again an excellent repair with no tension at all. Sutures were placed under direct vision. A 19-French Blake drain was left. The area was then closed with 3-0 Vicryl and the drain was sewn with 2-0 nylon and the skin was sewn with 2-0 nylon and staples.
THANKS