Wiki Repair of Rectus Diastasis

coderguy1939

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This is a suture/imbrication repair of a rectus diastasis (separation of stomach muscle). I've searched for a CPT code and have come up with nothing. If anyone has any experience with this kind of repair I'd appreciate some help.
 
This is a suture/imbrication repair of a rectus diastasis (separation of stomach muscle). I've searched for a CPT code and have come up with nothing. If anyone has any experience with this kind of repair I'd appreciate some help.

was this a secondary closure? grasping for straws here.

can you post the note?
 
No, this wasn't secondary. The doctor was doing an umbilical hernia repair and rectus diastasis imbrication. The diastasis existed prior to the surgery.

"We undermined the subcutaneous fatty tissue off of the anterior rectus sheath for approximately 5cm superior to the incision. We then imbricated the rectus with uninterrupted Prolene suture approximating the slight separation of the rectus muscle."
 
Yes, rectus procedure is bundled with the ventral hernia repair.

Method of repairing a patient's ventral hernia involves the steps of joining the patient's left and right rectus sheaths on opposite sides of the hernia, thereby closing the hernia, and cutting through the joined sheaths thereby forming one sheath interior containing the left and right rectus muscles. Additionally, sutures joining the left and right rectus sheaths are reinforced with reinforcing material.
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To MBORT:
Yes I liked your presentation. I enjoyed that statement!!!!
 
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I just wanted to add a recent article that came out in regards to hernia and diastasis recti repair. According to the below Coding Clinic, the repair of the diastasis recti would be considered part of the hernia repair. Please note, since this article came out the hernia repair codes are incorrect. We would want to report 49591-49618 for any anterior abdominal hernias repaired on or after 1/1/23.

Coding Clinic for HCPCS - Fourth Quarter 2022 Page: 16 Effective Date: December 6, 2022

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A patient presents for open repair of a diastasis rectus deformity and recurrent incisional hernia. An elliptical incision was made and extended superiorly to the xiphoid process. The umbilicus was removed and the fascia was entered above the region of the previous umbilical hernia repair. Anterior abdominal wall adhesions and prosthetic mesh from the previous incisional hernia were taken down via cautery. Lysis of adhesions continued as the midline fascial aperture was extended to the xiphoid process. The hernia defect was small, through the attenuated midline fascia and not involving the rectus musculature. The reconstruction was ultimately undertaken via the implantation of a 20 cm x 15 cm mesh prosthetic placed in the retrorectus position.

Starting on the right, the posterior rectus sheath was incised longitudinally at its most medial aspect and undertaken to the limits of the skin incision. Using blunt technique, this was undertaken to the level of the linea semilunaris. An identical operative technique was utilized on the left side and once the tissue planes were fully developed, the posterior rectus sheath was closed with a simple continuous suture. The mesh prosthetic was then placed into the retrorectus space with the gripping aspect of the mesh facing anteriorly. The rectus muscles were then retracted medially and placed down on the mesh. The redundant soft tissues inclusive of the fascia involved with the diastasis deformity were then resected with cautery and the linea alba reconstructed by reapproximating the anterior rectus sheath in the midline with a simple continuous suture. The subcutaneous tissues were reapproximated with simple interrupted sutures of 3-0 Vicryl and the skin closed with metal staples.

Can you clarify if the diastases recti repair can be reported separately with a hernia repair or is the diastases recti repair inherent to the hernia repair? If reported separately, would CPT code 22999, Unlisted procedure, abdomen, musculoskeletal system, be reported?

ANSWER

Assign CPT code(s) 49565, Repair recurrent incisional or ventral hernia; reducible and 49568, Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair), for the hernia repair with mesh insertion. In this case, the diastasis recti repair would not be reported separately; it would be considered part of the reconstruction and hernia repair. However, diastasis recti repair would be coded separately when it is in a different location from the hernia repair. In addition, assign HCPCS Level II code C1781, Mesh (implantable), for the mesh device.
 
Apparently you're supposed to report a lipectomy (1530) and then 15847 as an add-on code. Modifier 51 is not appended as it is an add-on code. Look up repair/abdominal wall or Abdominoplasty/excision/skin and tissue. It seems very roundabout to me. We need a CPT code for a straight-up diastasis recti repair!
 
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