Help w/ Hernia

LTibbetts

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I have a direct bilateral inguinal hernia repair, but one side was resected because of the size of the sac, rather than reduced. The other side was simply reduced. Do I just code the repair code with the bilateral modifier or do I code the resect sac seperately?

=One the right, a rather unusual long direct hernia sac was present and measured approx 8cm in length, through which the the small intestine was herniating. Due to the size of the sac and the tendancy for intestinal herniation, I elected to resect the sac instead of just reducing it under the mesh. The external oblique was opened into the external ring, and the spermatic cord was retracted with a penrose drain. The direct hernia was dissected free and again was a very large, long sac. I was uncomfortable with just ligating this, and I opened it and reduced it the small intestine and then put a Purstring suture under direct position, ensuring that the intestine was not included in the suturing. This sac was then resected. The stump of the sac was then reduced with a figure 8 suture. The cremaster muscle fibers were opened and the peritoneal reflection was identified to confirm that no ecteric sac was present. The floor of the canal was then reconstructed using mesh, securing the mesh inferiorly to the inguinal ligament, medial to the rectus sheath, supieriorly to the conjoint tendon and laterally.
Any help or additional info would be great!
 

mbort

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2,338
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ENGLEWOOD/DENVER
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I have a direct bilateral inguinal hernia repair, but one side was resected because of the size of the sac, rather than reduced. The other side was simply reduced. Do I just code the repair code with the bilateral modifier or do I code the resect sac seperately?

=One the right, a rather unusual long direct hernia sac was present and measured approx 8cm in length, through which the the small intestine was herniating. Due to the size of the sac and the tendancy for intestinal herniation, I elected to resect the sac instead of just reducing it under the mesh. The external oblique was opened into the external ring, and the spermatic cord was retracted with a penrose drain. The direct hernia was dissected free and again was a very large, long sac. I was uncomfortable with just ligating this, and I opened it and reduced it the small intestine and then put a Purstring suture under direct position, ensuring that the intestine was not included in the suturing. This sac was then resected. The stump of the sac was then reduced with a figure 8 suture. The cremaster muscle fibers were opened and the peritoneal reflection was identified to confirm that no ecteric sac was present. The floor of the canal was then reconstructed using mesh, securing the mesh inferiorly to the inguinal ligament, medial to the rectus sheath, supieriorly to the conjoint tendon and laterally.
Any help or additional info would be great!
Hi Leslie,
Since the 49505 includes resection of the hernia sac (see lay description) you would code the 49505-50 (assuming this is an open procedure and not lap)
 
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