Attempted hernia, exploration of r groin

ksb0211

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Deltona, FL
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Patient was scheduled for r inguinal hernia repair. The hospital has stated that this should be billed as a 49520 (repair recurrent inguinal hernia). I am just wondering if anyone else has any opinions on this one. (Oh, and FYI, the pathology report came back as: BENIGN CYSTIC LESION. HISTOLOGIC FINDINGS ARE CONSISTENT WITH TISSUES FROM A CLINICAL HERNIA SAC WITH CYST FORMATION). Thanks.

PREOPERATIVE DIAGNOSIS
Right inguinal hernia.
POSTOPERATIVE DIAGNOSIS
Mass right groin, possible spermatocele.

OPERATION PERFORMED
Exploration right groin, excision of mass.

DESCRIPTION OF PROCEDURE
The patient was taken to the OR. After induction of adequate general anesthesia, the patient was prepped with DuraPrep and draped sterilely. Perioperative antibiotics had been administered.
The initial incision was made in the right groin from the pubic tubercle superior laterally. Tissue was divided down to the level of the external oblique aponeurosis. Scarpa fascia was divided and venous structures were ligated. The superficial ring was surgically altered from previous repair. I entered the external oblique aponeurosis, the patient was noted to have a mass below this level. It was carefully dissected free from surrounding tissue. Venous structures as well as the vas were well identified. This mass appeared to have attachment extending towards the level of the deep ring. A definitive attachment to the vas was not seen. The attachment was then ligated with 3-0 Vicryl. The wound was inspected for hemostasis, it was well injected with Marcaine. There was no overt hernia appreciated. The external oblique aponeurosis was closed with interrupted 2-0 Vicryl suture. Subcutaneous tissue was closed with 3-0 Vicryl and a 4-0 Vicryl subcuticular stitch was utilized. Steri-Strips and Tegaderm applied. The patient tolerated the procedure well.
 

nrichard

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254
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Pensacola, Fl
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I don't see any repair of a hernia. What I do see is an excision of an abdominal mass. I would go with code range 49203-49205. Excision, open intra-abdominal tumors, CYSTS or endometriomas (then it goes by size) You'll need to query the physician to find out the size of the lesion removed.
 
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