Wiki Inguinal Hernia Repair? Need Help with Codes

[KBean2018]

Hello! I am not sure how to code the below procedure. Any assistance is appreciated

Excision of meshoma and neurectomy of the Genital branch of the GF nerve. Primary repair of the iatrogenic creation of the fascial defect using a primary suture technique and fascial release.

dx:Left inguinodynia. Cannot exclude recurrent left inguinal hernia. Status post bilateral laparoscopic inguinal hernia repair

thank you

 

[cgaston]

"Iatrogenic" means the Physician caused the injury. If this is the case you cannot bill for the repair that he/she caused.

 

[KBean2018]

Would you code as just an Inguinal Repair 49520?

DESCRIPTION OF PROCEDURE: The left inguinal area was prepped and draped in standard sterile fashion. The tender bulge of the left inguinal canal was marked preoperatively (probable meshoma). A standard left inguinal incision was performed. The incision was carried down through Scarpa's layer to the external oblique fascia. Upon entering the inguinal canal, an area of fibrotic tissue/mesh was identified within the Hesselbach's triangle anatomic space. The genital branch of the genitofemoral nerve was entrapped within the scar tissue, and divided following its dissection lateral to the internal ring within the musculature.
*
The patient was quite thin and did not approve of the meshoma. There was no obvious hernia medial or lateral to the fibrotic scar. The majority of the scar tissue was excised. Due to its incorporation into the inguinal ligament, this area of the mesh was left intact so as not to disturb the normal anatomy. The inferior epigastric vessels were identified and suture ligated with 3-0 silk. Following excision of the scar tissue, a 2 cm² area of fascial defect was identified. The iatrogenic defect was then repaired using interrupted 2-0 Prolene sutures by reapproximating the conjoined tendon to the reflected edge of the inguinal ligament. Medially a fascial release was performed of the rectus sheath to allow for a tensionless repair. Additional mesh was not placed. The wound was irrigated and hemostasis obtained. The cord was carefully inspected. There is no evidence of an occult indirect hernia. The external oblique fascia was closed using a running 3-0 Vicryl suture. Scarpa's layer was closed with interrupted 2-0 chromic. Local anesthesia was infiltrated. The skin was closed with a 4-0 Monocryl subcuticular suture and Dermabond.

Thank you in advance
*