Epigastric herina

codedog

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Doctor wants to bill this as an Epigastric Herina Repair -49570, not sure about if this is right, what do you think ?

PREOPERATIVE DIAGNOSIS: Recurrent incarcerated incisional hernia.

POSTOPERATIVE DIAGNOSIS: Recurrent incarcerated incisional hernia.

PROCEDURES PERFORMED: Removal of mesh and abdominal wall fascia with plication of abdominal wall in midline with running Prolene suture and skin removal.

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PROCEDURE IN DETAIL: The patient was taken to the operating after obtaining informed consent and placed on the operating table in the supine position. Following the achievement of adequate general endotracheal anesthesia, the patient's abdomen was prepped in its entirety with Betadine gel and sterilely draped.

The patient had a previous midline incision. The patient also had an incarcerated hernia in the past, which was repaired with Marlex mesh. Subsequently, the patient had a sleeve gastrectomy laparoscopically and the patient has lost sufficient weight that the hernia repair is lax and in need of reconstruction.

The incision was made to the midline and deepened to the subcutaneous tissue to the mesh and fascia. The superficial panniculus was elevated left and right. The mesh was incised gaining access to the peritoneal cavity and freeing of adhesions circumferentially.

The Marlex mesh was then cut away in large part; all of the mesh in the left side and most of the mesh on the right side. Secondary repair with Marlex mesh was also noted on the right side anteriorly, but this was left undisturbed.

The midline was then closed with running #1 Prolene suture and the skin was now redundant. An ellipse of skin was excised from both the right and left side, as a skin reduction surgery and this was excised. The subcutaneous tissue was closed with 3-0 Vicryl suture and the skin was closed with staples. The patient tolerated the procedure well, was awakened from general anesthesia without complications and transferred to the recovery room in satisfactory condition.
 

syllingk

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Boise, Idaho
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Sounds like a 49566 from the note. But epigastric wouldn't be totally wrong. Note states incarcerated so it would be 49572 if doctor felt more comfortable billing it that way.
 
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