- Messages
- 8
- Location
- New Providence, NJ
My provider insists that I bill hernia codes with 14301/14302. I explained that what he is describing is included in the 2023 hernia repair codes, but he insists these codes are billable. Comments/guidance? Thank you in advance!
Hernia Type: Spigelian x 2
Defect Size:
Vertical: 7 cm
Transverse: 3 cm
Myofascial Release: None
Mesh Type: 16 x 12cm ProGrip Mesh
Mesh Size:
Vertical: 16 cm
Transverse: 12 cm
Mesh Location: Preperitoneal
Mesh Fixation: Suture
Billed: 49594,14301,14302
We started by creating a large peritoneal flap for eventual tissue transfer to cover the large mesh required for this repair. We started medially around the medial ligament and carried superiorly > 4cm from the upper defect. The intermediate fascia was identified and we made sure to stay within the visceral compartment as we dissected laterally. The peritoneal flap was created with few defects from the dissection due to the thin nature of the flap. We identified the first defect with appendix herniation without inflammatory changes. The sac was carefully dissected free of the defect which measured 2cm in size. This was just lateral and superior to the internal ring. Roughly 3cm cephalad to this defect was a slightly larger defect with copious amount of incarcerated preperitoneal fatty tissue. This was reduced in its entirety and the defect was also measured to be roughly 2cm in size. We continued our flap creation to make sure there is > 4cm overlap circumferentially for both hernia defects to be covered by the mesh. Once competed the hernia defects were closed with #0 Stratafix suture in running fashion in 2 layers. A large ProGrip mesh was fashioned to size measuring 16cm x 12cm in size to allow for coverage of all the defects with > 4cm overlap. Mesh laid flat and inferior edge was positioned deep with no risk of lifting with the peritoneal flap closure. The mesh was secured anteriorly with 3-0 vicryl interrupted sutures in 2 different locations otherwise the mesh laid flat and secured in place using the self-Gripping system. The peritoneal flap was thin and we proceeded with closure. Pneumoperitoneum was dropped to 6mm Hg. The flap was closed with 2 3-0 absorbable Vloc sutures. The tissue flap was large enough to cover the entirety of the mesh. Once the tissue transfer closure was completed the defects in the flap was closed with additional 3-0 absorbable V-loc sutures.
Hernia Type: Spigelian x 2
Defect Size:
Vertical: 7 cm
Transverse: 3 cm
Myofascial Release: None
Mesh Type: 16 x 12cm ProGrip Mesh
Mesh Size:
Vertical: 16 cm
Transverse: 12 cm
Mesh Location: Preperitoneal
Mesh Fixation: Suture
Billed: 49594,14301,14302
We started by creating a large peritoneal flap for eventual tissue transfer to cover the large mesh required for this repair. We started medially around the medial ligament and carried superiorly > 4cm from the upper defect. The intermediate fascia was identified and we made sure to stay within the visceral compartment as we dissected laterally. The peritoneal flap was created with few defects from the dissection due to the thin nature of the flap. We identified the first defect with appendix herniation without inflammatory changes. The sac was carefully dissected free of the defect which measured 2cm in size. This was just lateral and superior to the internal ring. Roughly 3cm cephalad to this defect was a slightly larger defect with copious amount of incarcerated preperitoneal fatty tissue. This was reduced in its entirety and the defect was also measured to be roughly 2cm in size. We continued our flap creation to make sure there is > 4cm overlap circumferentially for both hernia defects to be covered by the mesh. Once competed the hernia defects were closed with #0 Stratafix suture in running fashion in 2 layers. A large ProGrip mesh was fashioned to size measuring 16cm x 12cm in size to allow for coverage of all the defects with > 4cm overlap. Mesh laid flat and inferior edge was positioned deep with no risk of lifting with the peritoneal flap closure. The mesh was secured anteriorly with 3-0 vicryl interrupted sutures in 2 different locations otherwise the mesh laid flat and secured in place using the self-Gripping system. The peritoneal flap was thin and we proceeded with closure. Pneumoperitoneum was dropped to 6mm Hg. The flap was closed with 2 3-0 absorbable Vloc sutures. The tissue flap was large enough to cover the entirety of the mesh. Once the tissue transfer closure was completed the defects in the flap was closed with additional 3-0 absorbable V-loc sutures.