- Messages
- 8
- Location
- Nacogdoches, TX
My coding team and I keep advising our provider that this documentation does not support reporting an incarcerated hernia but it says it does that we just do not understand clinically what is happening. Looking for any guidance do you agree it supports as incarcerated 49594 or not and reporting 49593 as easily reducible is described in the procedure details. thanks in advance for any help!
Pre-Operative Diagnosis: ventral hernia nonreducible
Next the ventral hernia was addressed. An incision was made into the preperitoneal fat in the superior abdomen superior to the defect itself which was right at the top edge of the umbilicus it was able to be circumferentially dissected and then free of surrounding tissue taking the peritoneum and preperitoneal fat off the underside of the musculature so that we could visualize the posterior fascial sheath this was done circumferentially around the hernia defect itself all hernia contents were preperitoneal fat mainly and when they were able to be reduced easily during this exposure. Once we did this the hernia was evaluated there is actually 2 small hole side-by-side because of this we closed the fascia in a transverse fashion with 0 PDS running barbed suture going both directions along the defect she secured in place. The suture was then brought out through the center portion of a 8 cm phasic saw round mesh that was secured in place with the transfascial suture and then circumferentially sutured with 2-0 PDS barbed suture to further secure it in place and then the preperitoneal cavity was closed with a 2-0 PDS running suture as well. This is repair of the hernia with adequate overlapping edges and primarily repaired with a mesh underlay. The abdomen was evaluated there was no evidence of damage to intra-abdominal structures or other pathology or other hernias that were evident. The gas was removed from the abdomen and the 2 lateral trocars removed from the abdomen under direct visualization. The final trocar was then removed from the abdomen. The port sites were irrigated with normal saline and the skin closed with 4-0 Monocryl interrupted sutures at all sites as well as Dermabond. There were no complications, the patient tolerated the procedure well, all sponge, needle, and instrument counts were correct at the end of the case. The patient was taken to recovery room in stable condition.
Pre-Operative Diagnosis: ventral hernia nonreducible
Next the ventral hernia was addressed. An incision was made into the preperitoneal fat in the superior abdomen superior to the defect itself which was right at the top edge of the umbilicus it was able to be circumferentially dissected and then free of surrounding tissue taking the peritoneum and preperitoneal fat off the underside of the musculature so that we could visualize the posterior fascial sheath this was done circumferentially around the hernia defect itself all hernia contents were preperitoneal fat mainly and when they were able to be reduced easily during this exposure. Once we did this the hernia was evaluated there is actually 2 small hole side-by-side because of this we closed the fascia in a transverse fashion with 0 PDS running barbed suture going both directions along the defect she secured in place. The suture was then brought out through the center portion of a 8 cm phasic saw round mesh that was secured in place with the transfascial suture and then circumferentially sutured with 2-0 PDS barbed suture to further secure it in place and then the preperitoneal cavity was closed with a 2-0 PDS running suture as well. This is repair of the hernia with adequate overlapping edges and primarily repaired with a mesh underlay. The abdomen was evaluated there was no evidence of damage to intra-abdominal structures or other pathology or other hernias that were evident. The gas was removed from the abdomen and the 2 lateral trocars removed from the abdomen under direct visualization. The final trocar was then removed from the abdomen. The port sites were irrigated with normal saline and the skin closed with 4-0 Monocryl interrupted sutures at all sites as well as Dermabond. There were no complications, the patient tolerated the procedure well, all sponge, needle, and instrument counts were correct at the end of the case. The patient was taken to recovery room in stable condition.