Add On Code 49568

MelBarclay

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San Antonio, TX
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A parastomal hernia was repair with a omental flap and I'm wanting to make sure that can be billed along with the hernia code. I'll post the entire operative course below. I'm thinking 49560 and 49568 but I'm not sure if omentum rather than mesh can be billed.

Operative Course:
A midline incision was performed. The fascia opened and a loop of small bowel was seen in the parastomal hernia. We did not go through the ostomy site because I do not think there was enough room to reduce this and repaired this safely and I wanted to do it from the inside with omental flap. The small bowel was reduced without any complication by manual reduction. There was no ischemia. Everything was completely viable and I ran the small bowel at the ligament of Treitz and ran it all the way distally to the ileocecal valve and there was no remaining obstructions or issues, no adhesions, no abscess. Everything was clean and dry. I tightened up the ostomy site with Vicryl and UR-6 with 3 interrupted sutures and then I placed omentum around this and sutured this in with 3-0 silk pop-offs. Everything looked good and there was no further opening for small bowel to get in. At this point, the
fascia was closed with a #1 looped PDS stitch. Four retention sutures were placed under direct visualization with a red rubber catheter. Everything was sutured down tight and the skin closed with staples. Dressings placed. New ostomy bag placed.

Any input would be greatly appreciated!
 

dkissel

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Flint, MI
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It appears as though you would have to use the omental flap rather than the mesh code as I don't see anything supporting 49568. There are no NCCI edits for 49560 with +49905 (Omental pedical flap) as it is an add on code.
 

MelBarclay

Networker
Messages
26
Location
San Antonio, TX
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It appears as though you would have to use the omental flap rather than the mesh code as I don't see anything supporting 49568. There are no NCCI edits for 49560 with +49905 (Omental pedical flap) as it is an add on code.
Thank you! I don't know why I didn't think of that.
 
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