- Messages
- 7
- Location
- Nacogdoches, TX
Good afternoon, I am looking for clarification can a resection of an ilioinguinal nerve (64772) be billed with inguinal hernia repair (49505/49507)? Here is a report I am working with and I cannot find any CMS guidelines and they do not hit a CCI edit when checked together.
With patient in supine position, we proceed to drape and prep
the abdomen in usual sterile manner. We started by doing a low transverse abdominal incision dissecting Camper's and Scarpa's in superficial planes.
While we mobilized all these, we incised through the external oblique aponeurosis.
We entered the abdominal cavity we then defy a volvulus of the small intestine and we reduced it to the normal position and was reduced back into the abdominal cavity and that area was closed with
We then following with the inguinal repair as follows, we proceeded to identification and transection for the nerve to avoid chronic pain syndrome. After that with very fine dissection cord structures were identified and mobilized away for hernia defects.
The defect was repaired with a plug of polypropylene, which was secured with 4 different points to inguinal ligament,
conjoint tendon and external opening of the inguinal canal with #1 PDS.
We noticed there was tension over the repair and we did proceed to do external oblique aponeurosis release followed by interrupted places of figure-of-eight PDS suture from the inguinal ligament to the fascia of the external obliques to cover completely the defect, we gained about 4 to 5 cm of mobilization of this fascial myocutaneous flap
Then proceeded a patch of polypropylene mesh and secured in a running fashion to the conjoint tendon, inguinal ligament and the symphysis of the pubis with a very good result.
We proceeded to do lavage and drainage of the surgical bed and continue with standard layered closure with absorbable material.
Patient tolerated well the procedure, successfully extubated and transferred
to Postanesthesia Unit to recover room.
With patient in supine position, we proceed to drape and prep
the abdomen in usual sterile manner. We started by doing a low transverse abdominal incision dissecting Camper's and Scarpa's in superficial planes.
While we mobilized all these, we incised through the external oblique aponeurosis.
We entered the abdominal cavity we then defy a volvulus of the small intestine and we reduced it to the normal position and was reduced back into the abdominal cavity and that area was closed with
We then following with the inguinal repair as follows, we proceeded to identification and transection for the nerve to avoid chronic pain syndrome. After that with very fine dissection cord structures were identified and mobilized away for hernia defects.
The defect was repaired with a plug of polypropylene, which was secured with 4 different points to inguinal ligament,
conjoint tendon and external opening of the inguinal canal with #1 PDS.
We noticed there was tension over the repair and we did proceed to do external oblique aponeurosis release followed by interrupted places of figure-of-eight PDS suture from the inguinal ligament to the fascia of the external obliques to cover completely the defect, we gained about 4 to 5 cm of mobilization of this fascial myocutaneous flap
Then proceeded a patch of polypropylene mesh and secured in a running fashion to the conjoint tendon, inguinal ligament and the symphysis of the pubis with a very good result.
We proceeded to do lavage and drainage of the surgical bed and continue with standard layered closure with absorbable material.
Patient tolerated well the procedure, successfully extubated and transferred
to Postanesthesia Unit to recover room.
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