lbermudez@mms-ms.com
Contributor
Hello, I'm looking for a second opinion. I'm not sure if 49320 or 49650 is appropriate for the following procedure - ( maybe I'm overthinking this or I have it all wrong haha)
"With the patient in supine position general tracheal anesthesia was administered and his abdomen was prepped and sterilely draped with an Ioban.
After infiltration with local anesthetic intra-abdominal access was obtained with an 8 mm robotic trocar with a transparent obturator inserted a few cm above the umbilicus. A pneumoperitoneum was established with carbon dioxide. To 8 mm robotic trochars were placed in both subcostal areas, flanking the midline trocar. The patient was placed in Trendelenburg position. The robot was then docked and the procedure performed from the console.
The peritoneum along the right side was incised and the peritoneum dissected off the undersurface of transversalis fascia. Dissection was performed the point that it could see the Cooper's ligament and pubic tubercle medially. The epigastric vessels were tracked down to the cord structures. There was no indirect inguinal hernia sac and large right direct defect. The sac and peritoneum were dissected off the cord structures to well beyond the split of the vas deferens and the vessels.
Next, a anatomic right progrip mesh was positioned over the space to well cover all potential groin hernia defects.
The peritoneum was then closed with running 3-0 Monocryl Stratafix suture. The pneumoperitoneum was deflated and trochars were removed. Each of the skin incisions were closed with 4-0 Monocryl subcuticular sutures. The incisions were cleaned and dried and Mastisol and Steri-Strips were applied"
Thank you!
"With the patient in supine position general tracheal anesthesia was administered and his abdomen was prepped and sterilely draped with an Ioban.
After infiltration with local anesthetic intra-abdominal access was obtained with an 8 mm robotic trocar with a transparent obturator inserted a few cm above the umbilicus. A pneumoperitoneum was established with carbon dioxide. To 8 mm robotic trochars were placed in both subcostal areas, flanking the midline trocar. The patient was placed in Trendelenburg position. The robot was then docked and the procedure performed from the console.
The peritoneum along the right side was incised and the peritoneum dissected off the undersurface of transversalis fascia. Dissection was performed the point that it could see the Cooper's ligament and pubic tubercle medially. The epigastric vessels were tracked down to the cord structures. There was no indirect inguinal hernia sac and large right direct defect. The sac and peritoneum were dissected off the cord structures to well beyond the split of the vas deferens and the vessels.
Next, a anatomic right progrip mesh was positioned over the space to well cover all potential groin hernia defects.
The peritoneum was then closed with running 3-0 Monocryl Stratafix suture. The pneumoperitoneum was deflated and trochars were removed. Each of the skin incisions were closed with 4-0 Monocryl subcuticular sutures. The incisions were cleaned and dried and Mastisol and Steri-Strips were applied"
Thank you!