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Hernia and lipoma repair


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I am so stuck on this one, any advice on this would be greatly appreciated!!!

Basically what happened is this patient came in for multiple incisional hernia repair and it turned out that the two large ones were actually lipomas (NOT cord lipomas), which were removed in addition to the 2 incisional hernia repairs (one epigastric-incisional and one umbicical-incisional). Since they were both incisional I'm wondering if I can only use the 49560 code once? How many hernia repairs and lipoma removals can I code since there were 2 of each?
Also do I use the 22903 (soft tissue, subcutaneous) lipoma removal code or in the 11xxx section for subcutaneous?? Both say subcutaneous so I am not sure what to do.

Right now I'm thinking 49560 (just once); 49568 (mesh, since it was incisional hernias); and 22903-59 (just once) for the lipoma removal (path report lengths add up to be over 4 cm combined).Thanks!!!

Katie, RHIT

Scrubbed OP Note:
...An abdominal incision was made along the previous incision and we removed the skin from the previous scar. I then dissected down to the fascial level. While doing so, I encountered 2 large subcutaneous abdominal lipomas that originally felt like hernia defects on his abdominal wall and these were removed. These were not hernia defects, but there was a hernia defect in the epigastric area, as well as in the umbilical area. The umbilical one was larger and was 3 cm x 4 cm. The upper one was 1.5 x 2 cm in size. These were not incarcerated with bowel. I went ahead and freed the subcutaneous tissue from them. There were no other hernia defects noted in the midline along the midline scar. I placed 2 pieces of mesh within these. In the top one we used a Ventralex medium mesh and sutured around the fascia. On the lower, larger defect I used Ventralex ST large and placed this within the cavity and sutured thiswith 8 sutures of 0 Surgilon suture around the circumference anchoring it after creating a space large enough below to accommodate the mesh. I closed the subcutaneous tissue with a running 0 Vicryl suture and closed the skin with staples....


Best answers
You can charge for each lipoma separately, but I don't see that your dr dictated a size on them. Maybe he can amend this and add them? I would charge 49560, 49568, 22903, 22903-59 or 22902 and 22902-59 depending on the size. Just my opinion. We code and get paid for multiple lipoma excisions frequently.