How do you code a umbilicoplasty with hernia repair?

jdibble

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I need some help coding this surgery. The doctor did an umbilical hernia repair with an umbilicoplasty. There is no code for the umbilicoplasty. How would I code that part of the procedure? Would it be included in the hernia repair code? I've seen some suggestions to use 15830 and 15847, however I am not sure if those are appropriate for this. My other thought is to use a complex repair code. Has anyone coded this before? Any help I can get would be greatly appreciated!!

Preoperative Diagnosis
LARGE UMBILICAL HERNIA

Postoperative Diagnosis
SAME

Procedure Performed
UMBILICAL HERNIORRHAPHY AND UMBILICOPLASTY

Type of Anesthesia
General endotracheal, transabdominal peritoneal block

Indications
The patient is a ___year-old woman who was being followed for over a year with an umbilical hernia that was increasing in size and becoming more symptomatic. Options for repair have been discussed and she agreed with open repair and umbilicoplasty, since it had been distorted. The possible risks, benefits and complications of umbilical herniorrhaphy and umbilicoplasty was discussed. She finally agreed proceed with surgery.

Findings
Large umbilical hernia with redundant hernia sac and redundant skin
actual defect ~3.4cm

Unanticipated Events/Complications
None apparent

Specimen(s) HERNIA SAC

Technique/Description of Procedure
Patient was brought to the or on _________ and placed on table in supine position. After adequate general anesthesia, the patient was prepped and draped in a sterile fashion. An allis clamp was used to lift up the umbilicus and a semicircular incision was made in the infraumbilical space. The incision was carried down the subcutaneous tissue and scarpa's fascia was divided. A tonsil clamp was used to dissect widely around the umbilicus until the hernia sac was isolated.care was taken to carefully dissect through the layers of the hernia sac. The hernia sac was noted to have omentum as contents that were reduced back into the peritoneal cavity after electro bovie cautery was used to control oozing. The large hernia sac was grasped and resected with the electrocautery. The edges of the fascia were cleaned off and grasped with allis clamps. The fascia was approximated with 0 ethibond stitches in a figure of 8 fashion. They were tacked with hemostats until all were placed. Inspection was undertaken to ensure no intra-abdominal contents were in the stitches. The stitches were then tied individually. Hemostats were used to retract up the stitches to checked the space between the suture repair. Another 0 ethibond stitch was placed between the stitches that were greater than a 1/2 centimeters apart.

Irrigation was undertaken. 0.5% marcaine was injected to the area along the stitches and fascia, then the subcutaneous tissue and the umbilical flap. The umbilical flap was secured back down to the fascia with 0 ethibond stitch to recreate the umbilicus. Then interrupted 3 0 vicryl stitches were used to approximate the scarpa's fascia and subcutaneous tissue. The excess skin was then measured out and excised. The skin was approximated with 4 o monocryl running subcuticular stitch. Mastisol, steri-strips and a cotton ball in the umbilicus, telfa and tegaderm were placed for dressing. The hypodermic needle was used to create a vacuum seal in the dressing. The patient tolerated the procedure well. The patient was extubated and brought to recovery room in stable condition.

Thanks, :D

Jodi Dibble, COC, CPC
 
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