Callieb
Guest
Patient had a recurrent sm bowel obstruction 2nd to incarerated incisional hernia/parastomal hernia ileal conduit with clear transition point within the hernia sac, involving the terminal ileum.
Procedure - Exp laparotomy through parastomal incision, resection of ileal conduit, repair of colotomy cecum and repair of incarcerated ventral incisional hernia by primary intention.
Body of report reads: Incision made around the ileal conduit and carried down sharply into subq tissue. Hernia sac was encountered immediately adherent to the skin, inferiorly and laterally. Incision was made and we entered what appeared to be the colon. All tissue within the hernia sac was mobilized. Redundant sac excised. Small bowel was delivered outside of the sac, there appeared to be a twist with the transition point of the distal ileum. This was freed up entirely and proximal ileum was dilated. This was felt to be point of chronic obstruction. Bowel was then reduced to the abd cavity, all adhesions freed up. Colotomy was repaired by stapler device transversely across cecum. Colon was delivered back to abd after approx. 1 hr lysis of adhesions. The conduit itself was dissected free from surrounding structures to near the base of the conduit toward the pelvis. Conduit was sent for path. Defect in abdominal wall was further mobilized and all adhesions to anterior abdominal wall were freed up. At this point urology was called in to do a nephrectomy. The hernia defect was then closed.
Would this be like closure of enterostomy, large or small intestine 44620 or repair of the hernia 49566 or both? Do I need to worry about a modifier for the other surgeon? It seems we did our part and closed and he did his part? As I was reading and typing this I'm starting to think hernia with 22 modifier?
Procedure - Exp laparotomy through parastomal incision, resection of ileal conduit, repair of colotomy cecum and repair of incarcerated ventral incisional hernia by primary intention.
Body of report reads: Incision made around the ileal conduit and carried down sharply into subq tissue. Hernia sac was encountered immediately adherent to the skin, inferiorly and laterally. Incision was made and we entered what appeared to be the colon. All tissue within the hernia sac was mobilized. Redundant sac excised. Small bowel was delivered outside of the sac, there appeared to be a twist with the transition point of the distal ileum. This was freed up entirely and proximal ileum was dilated. This was felt to be point of chronic obstruction. Bowel was then reduced to the abd cavity, all adhesions freed up. Colotomy was repaired by stapler device transversely across cecum. Colon was delivered back to abd after approx. 1 hr lysis of adhesions. The conduit itself was dissected free from surrounding structures to near the base of the conduit toward the pelvis. Conduit was sent for path. Defect in abdominal wall was further mobilized and all adhesions to anterior abdominal wall were freed up. At this point urology was called in to do a nephrectomy. The hernia defect was then closed.
Would this be like closure of enterostomy, large or small intestine 44620 or repair of the hernia 49566 or both? Do I need to worry about a modifier for the other surgeon? It seems we did our part and closed and he did his part? As I was reading and typing this I'm starting to think hernia with 22 modifier?