frankal
Contributor
Can 49655 be coded twice. One with a -22 modifier and the other one with modifiers -59 or -51? Our physician did 2 laparoscopic incarcerated incisional hernia repairs. One in the right upper quadrant and the other just left of pt's umbilicus. There were 2 different mesh placements.
The robotic arms were then brought up to the patient's bedside and
secured to the port. The camera and robotic instruments were then inserted. I then moved
over to the robotic console and took control of the camera and instruments. The careful
thorough inspection was made around the abdominal cavity. We then initially began dissecting
out the incarcerated omentum from the periumbilical incisional hernia. The omentum was
carefully freed up using blunt dissection and scissors with electrocautery. We partially
reduced the omentum, but then had to transect part of the omentum as it was not easily freed
up from the hernia sac. We then completely reduced the remaining incarcerated omentum and
removed the hernia sac using scissors with electrocautery. This allowed us to easily
visualized the fascial edges of the hernia defect. The hernia was measured and was measuring
approximately 2 cm. The hernia defect was then reapproximated using 0 V-Loc permanent
running suture. This was sutured closed in a transverse fashion as the fascia appeared to
come together easier and the transverse orientation. Pneumoperitoneum was dropped down to 10
mmHg to allow better compliance of the abdominal wall. We then used a spinal needle to
identify the mid portion of the repair and then made a small nick incision at the skin and
advanced the GraNee needle into the center portion of the repair. A 9 cm piece of Symbotex
mesh was then chosen to repair this. The mesh was tagged with an 0 Vicryl suture in the mid
portion and this was then rolled up in placed within the abdominal cavity. The mesh was then
further the suture on the mesh was then grasped with a GraNee needle and brought up through
the center portion of the hernia defect. With the mesh in proper orientation, we then
secured the mesh to the fascia using 0 V-Loc absorbable running suture. Once the mesh was
sewn in place circumferentially, it was then carefully inspected and the mesh repair appeared
secure. No further abnormalities were identified. We then moved our attention over to the
left upper quadrant hernia. Again, the hernia defect was incarcerated with omentum. This
omentum was carefully dissected free using blunt dissection and scissors with electrocautery.
With careful dissection, we eventually did reduce the entire incarcerated omentum. The
fascial edges were clearly visible and the hernia defect was measured. The hernia was
measuring approximately 2 cm as well. This again was repaired using an 0 V-Loc permanent
running suture. A GraNee needle was then passed through the center portion of the hernia
defect and again we used a 9 cm round Symbotex mesh with an 0 Vicryl suture tag in the
middle. The suture was brought up through the center of the hernia defect with the GraNee
needle. The mesh was then placed in proper orientation, centered on the hernia and then it
was secured in place using a 0 V-Loc absorbable running suture. Once that was sutured in
place circumferentially, the repair was carefully inspected and this appeared secure. One
final inspection was made around the repairs and no other abnormalities were identified.
Can someone please give me their opinion?
Thanks!
The robotic arms were then brought up to the patient's bedside and
secured to the port. The camera and robotic instruments were then inserted. I then moved
over to the robotic console and took control of the camera and instruments. The careful
thorough inspection was made around the abdominal cavity. We then initially began dissecting
out the incarcerated omentum from the periumbilical incisional hernia. The omentum was
carefully freed up using blunt dissection and scissors with electrocautery. We partially
reduced the omentum, but then had to transect part of the omentum as it was not easily freed
up from the hernia sac. We then completely reduced the remaining incarcerated omentum and
removed the hernia sac using scissors with electrocautery. This allowed us to easily
visualized the fascial edges of the hernia defect. The hernia was measured and was measuring
approximately 2 cm. The hernia defect was then reapproximated using 0 V-Loc permanent
running suture. This was sutured closed in a transverse fashion as the fascia appeared to
come together easier and the transverse orientation. Pneumoperitoneum was dropped down to 10
mmHg to allow better compliance of the abdominal wall. We then used a spinal needle to
identify the mid portion of the repair and then made a small nick incision at the skin and
advanced the GraNee needle into the center portion of the repair. A 9 cm piece of Symbotex
mesh was then chosen to repair this. The mesh was tagged with an 0 Vicryl suture in the mid
portion and this was then rolled up in placed within the abdominal cavity. The mesh was then
further the suture on the mesh was then grasped with a GraNee needle and brought up through
the center portion of the hernia defect. With the mesh in proper orientation, we then
secured the mesh to the fascia using 0 V-Loc absorbable running suture. Once the mesh was
sewn in place circumferentially, it was then carefully inspected and the mesh repair appeared
secure. No further abnormalities were identified. We then moved our attention over to the
left upper quadrant hernia. Again, the hernia defect was incarcerated with omentum. This
omentum was carefully dissected free using blunt dissection and scissors with electrocautery.
With careful dissection, we eventually did reduce the entire incarcerated omentum. The
fascial edges were clearly visible and the hernia defect was measured. The hernia was
measuring approximately 2 cm as well. This again was repaired using an 0 V-Loc permanent
running suture. A GraNee needle was then passed through the center portion of the hernia
defect and again we used a 9 cm round Symbotex mesh with an 0 Vicryl suture tag in the
middle. The suture was brought up through the center of the hernia defect with the GraNee
needle. The mesh was then placed in proper orientation, centered on the hernia and then it
was secured in place using a 0 V-Loc absorbable running suture. Once that was sutured in
place circumferentially, the repair was carefully inspected and this appeared secure. One
final inspection was made around the repairs and no other abnormalities were identified.
Can someone please give me their opinion?
Thanks!