bonnienorth55
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Hello, I have a patient who had a lap para ileostomy hernia repair with mesh done in the outpatient setting (Was discharged same day). Our office billed 49622 but of course that was denied due to it being a status C code for inpatient only. 44346 and 44314 have been considered as alternatives but there was no revision/repair of the ileostomy itself...this is the main body of the op report if anyone has some insight:
"The robotic port with a clear view tip and 0 degree camera where it was used to enter the abdomen safely. There were some minor adhesions along the left anterior abdominal wall which were taken down after placing the camera port. Patient was then placed in the right side up position. Upon inspecting the para ileostomy hernia there were multiple loops of small bowel which were stuck in the hernia which were removed by taking down the adhesions. Once having the small bowel out of the hernia the peritoneum surrounding the fascial defect was incised and a preperitoneal pocket was made. There was dense scar tissue on the upper midportion and I was unable to release the peritoneum from that location. Once having the preperitoneal pocket made the fascia layer was closed with a running #1 strata fix closing the defect around the ileostomy but not encroaching on the. Once having the fascial defect closed a 4 x 6 inch Bard BX coated mesh was fashioned in a keyhole fashion. The mesh was then placed over the repair and around the ileostomy. The 2 limbs were sutured together and then the mesh was secured to the abdominal wall with a running OV lock. This closed nicely around the stoma. I was able to easily insert the Prograf and the fascial plane without encroaching on the stoma. The peritoneum was then closed with a running 2 oh V-Loc burying the suture. At the edge of the peritoneum where he could not close it completely the peritoneum was secured down on the edge to the mesh. Inspection around the stoma revealed that there was a peritoneal defect in the left inferior which was closed with a another suture. Was being satisfied with the closure and covering his much of the mesh as possible the abdomen was desufflated and trochars were then removed after. Skin incisions were closed with subcuticular 4-0 Monocryl and Dermabond skin adhesive."
Thanks in advance for any help/tips!
"The robotic port with a clear view tip and 0 degree camera where it was used to enter the abdomen safely. There were some minor adhesions along the left anterior abdominal wall which were taken down after placing the camera port. Patient was then placed in the right side up position. Upon inspecting the para ileostomy hernia there were multiple loops of small bowel which were stuck in the hernia which were removed by taking down the adhesions. Once having the small bowel out of the hernia the peritoneum surrounding the fascial defect was incised and a preperitoneal pocket was made. There was dense scar tissue on the upper midportion and I was unable to release the peritoneum from that location. Once having the preperitoneal pocket made the fascia layer was closed with a running #1 strata fix closing the defect around the ileostomy but not encroaching on the. Once having the fascial defect closed a 4 x 6 inch Bard BX coated mesh was fashioned in a keyhole fashion. The mesh was then placed over the repair and around the ileostomy. The 2 limbs were sutured together and then the mesh was secured to the abdominal wall with a running OV lock. This closed nicely around the stoma. I was able to easily insert the Prograf and the fascial plane without encroaching on the stoma. The peritoneum was then closed with a running 2 oh V-Loc burying the suture. At the edge of the peritoneum where he could not close it completely the peritoneum was secured down on the edge to the mesh. Inspection around the stoma revealed that there was a peritoneal defect in the left inferior which was closed with a another suture. Was being satisfied with the closure and covering his much of the mesh as possible the abdomen was desufflated and trochars were then removed after. Skin incisions were closed with subcuticular 4-0 Monocryl and Dermabond skin adhesive."
Thanks in advance for any help/tips!
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