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Old 06-06-2012, 12:58 PM
hpierce hpierce is offline
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Question groin exploration, removal mesh, neurectomy??

Can anyone provide any guidance on the proper CPT coding for this procedure? I'm thinking 49505-RT, 22999, and 64999. Am I heading the right direction? Thanks, Heather, CPC

POSTOPERATIVE DIAGNOSIS: Right groin pain after inguinal hernia repair.
PROCEDURE: Right groin exploration, removal of implanted mesh, right ilioinguinal and genitofemoral neurectomies, right inguinal hernia repair without mesh.
FINDINGS: Mesh was present. No abnormalities of the mesh were seen. The ilioinguinal and genitofemoral nerves were identified and divided.
DESCRIPTION OF PROCEDURE:
After obtaining informed consent, patient was taken to the operating room, placed on the operating table in supine position. After induction of general anesthetic, she was prepped and draped using ChloraPrep. Her previous right inguinal incision was opened with a #10 blade. This was continued down through subcutaneous tissues using cautery. We were able to identify the external oblique aponeurosis. This was opened with a knife and then a general exploration was undertaken. We were able to dissect the mesh that was present down to the level of the inguinal ligament, tendon around the internal ring were sutured into place. We were able to identify what appeared to be the ilioinguinal and genitofemoral nerves entering into this area. Both of these were caught up in scarring process with the mesh and both were divided. Following this, the mesh was removed from all of the surrounding structures. We were able to dissect off the broad ligament, off the inguinal ligament, off the conjoint tendon slightly anterior to adjacent structures and this was removed. There did not appear to be any definitive abnormality ______. There may have been a few small folds, but nothing out of the ordinary. Once this was removed, all the sutures had been placed previously were also removed with several Prolene sutures. I then elected to close the defect primarily that was created by removing the mesh by approximating the inguinal ligament to the conjoint tendon, the whole length of the incision. No other structures were identified that could have been nerve, other than those that were divided. Following this, after carefully ensuring the hemostasis, the external oblique aponeurosis was re-approximated with interrupted 3-0 silks. Subcutaneous tissues were closed with running 3-0 Vicryl and skin was closed with 4-0 Vicryl in a subcuticular fashion. Steri-Strips were applied. Dressings were applied. The patient was taken to the recovery room in satisfactory condition.
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