ksrkelly7
Networker
Please review OP report below. The doc used HD Flex implant for abdominal repair following an endometrioma removal. He also did a small umbilical hernia. He coded the mesh implant of 49568 but I think he can use 15777. He used the implant following the large endometrioma removal not for the hernia. Can I bill this? CPT 49205, 49585 and 15777. (the 49205 was based on path report not attached.) Or not bill 49585 at all.
Indication for Surgery
Painful nodule, supra-pubic area, umbilical hernia and diastasis recti
Preoperative Diagnosis
Painful nodule, possible endometrioma, umbilical hernia and diastasis recti
Postoperative Diagnosis
Endometrioma of the abdominal wall, umbilical hernia, diastasis recti
Operation
Excision of abdominal wall endometrioma with umbilical hernia and diastasis recti repair with graft implantation
Findings
There did appear to be an endometrioma of the suprapubic area. There was diastasis recti and a small umbilical hernia found. A Flex HD graft was implanted.
Specimen(s)
Endometrioma
Technique
After pre-operative evaluation and informed consent was obtained, the patient was brought to the operating room. She was placed under suitable general anesthesia with laryngotracheal mask intubation. Sequential compression devices were applied. IV antibiotics were administered. A surgical pause was performed to confirm the patient identification and correct surgical procedure. The patient was then prepared and 3 minutes of drying time for the prep was allowed prior to draping the patient in the usual sterile fashion.
Local anesthetic was instilled into the area of her previous scar. The incision was made through her previous scar. This was carried down through the subcutaneous tissues to the fascia using the electrocautery device. The subcutaneous fat was elevated off the anterior abdominal wall using the electrocautery device and blunt dissection. This was carried to just above the umbilicus. The nodular density was palpated below the anterior rectus sheath to the right of midline. The fascia was opened overlying the mass and the mass was excised using the electrocautery device. All the indurated tissue was excised and sent to pathology. The linea alba and the umbilical hernia defect was closed using figure of eight 0 Prolene suture. The fascial defect where the endometrioma was excised was also closed using 0-Prolene suture. The 8 x 12 cm Flex HD graft was hydrated and rinsed. This was placed on top of the abdominal wall and sutured to the abdominal wall circumferentially using 0-PDS interrupted suture. The wound was copiously irrigated with saline solution. The 15 French Blake drain was placed in the wound and brought out through a stab wound incision. This was sutured to the skin using 2-0 Nylon suture. The subcutaneous tissues were approximated using 3-0 Vicryl suture. The skin was closed using 4-0 Monocryl suture. Dermabond and a Coverderm dressing were applied. The patient was awakened out of anesthesia, extubated and transported to the recovery room in fair condition. Classification of wound is clean-other.
Thanks for your help.
Kelly cpc-a
Indication for Surgery
Painful nodule, supra-pubic area, umbilical hernia and diastasis recti
Preoperative Diagnosis
Painful nodule, possible endometrioma, umbilical hernia and diastasis recti
Postoperative Diagnosis
Endometrioma of the abdominal wall, umbilical hernia, diastasis recti
Operation
Excision of abdominal wall endometrioma with umbilical hernia and diastasis recti repair with graft implantation
Findings
There did appear to be an endometrioma of the suprapubic area. There was diastasis recti and a small umbilical hernia found. A Flex HD graft was implanted.
Specimen(s)
Endometrioma
Technique
After pre-operative evaluation and informed consent was obtained, the patient was brought to the operating room. She was placed under suitable general anesthesia with laryngotracheal mask intubation. Sequential compression devices were applied. IV antibiotics were administered. A surgical pause was performed to confirm the patient identification and correct surgical procedure. The patient was then prepared and 3 minutes of drying time for the prep was allowed prior to draping the patient in the usual sterile fashion.
Local anesthetic was instilled into the area of her previous scar. The incision was made through her previous scar. This was carried down through the subcutaneous tissues to the fascia using the electrocautery device. The subcutaneous fat was elevated off the anterior abdominal wall using the electrocautery device and blunt dissection. This was carried to just above the umbilicus. The nodular density was palpated below the anterior rectus sheath to the right of midline. The fascia was opened overlying the mass and the mass was excised using the electrocautery device. All the indurated tissue was excised and sent to pathology. The linea alba and the umbilical hernia defect was closed using figure of eight 0 Prolene suture. The fascial defect where the endometrioma was excised was also closed using 0-Prolene suture. The 8 x 12 cm Flex HD graft was hydrated and rinsed. This was placed on top of the abdominal wall and sutured to the abdominal wall circumferentially using 0-PDS interrupted suture. The wound was copiously irrigated with saline solution. The 15 French Blake drain was placed in the wound and brought out through a stab wound incision. This was sutured to the skin using 2-0 Nylon suture. The subcutaneous tissues were approximated using 3-0 Vicryl suture. The skin was closed using 4-0 Monocryl suture. Dermabond and a Coverderm dressing were applied. The patient was awakened out of anesthesia, extubated and transported to the recovery room in fair condition. Classification of wound is clean-other.
Thanks for your help.
Kelly cpc-a