Wiki Laparoscopic Muscle Flaps When Done In Conjunction With Hernia Repairs

[Stephanie_Miller]

Good morning!

I was wondering if anyone was seeing their physicians performing the TAR flaps done via laparoscopy when doing hernia repairs? If so, how do you code for this?
My physicians occasionally perform 15734 along with their hernia repairs; however I am consistently beginning to see this being done via laparosopy also. Since 15734 is technically an open procedure code, I was wondering how everyone else was coding this?

Example:
The robot was docked. Using scissors and a grasper I started by attempting to take down the peritoneum transversely hoping to use this as my flap to perform a T APP repair. Unfortunately scar tissue and the significant diastases in the infraumbilical position did not allow for this. I therefore opened up the posterior rectus sheath transversely several centimeters above the defect and then took this dissection down exposing the rectus muscles and getting into the retrorectus space flaps on either side were created and the diastases was exposed. As I continued the dissection laterally on both sides I transition from the retrorectus space through the rectus fascia and into the preperitoneal plane to complete infraumbilical TAR flaps on either side. These were taken down inferiorly all the way to the groin. I was able to achieve adequate flap dissection to be able to bring the posterior sheath in the midline.

Thanks so much for your help,
Have an incredible weekend!
Stephanie Jones, CPC, CPMA, CGSC

 

[NM36]

I know this is old, but I'm curious if anyone has had success in getting paid for the component separations with complex hernia repairs.

We used to code the 15734 (for each side) when done with an open hernia repair. We rarely had any problem getting paid.

Then the doctors started doing it laparoscopically, and the trouble started. We tried reporting with the 15734, sometimes used an unlisted code, and as a last resort, reported the hernia repair code with the 22 modifier. We had mixed results, but I feel the 15734 is the best way to report this. Even though it's an implied open procedure, there is no laparoscopic equivalent, and payers really do not like unlisted codes.

If anyone has any success in getting paid for the laparoscopic/robotic component separation, how do you handle it??

We are consistently getting denials saying "procedure not described in the note" or some similar denial reason. But from what I can see, the doctor goes into great detail describing exactly what he did, developing the plane between the rectus muscle and the posterior rectus sheath, incising the posterior rectus sheath medially, dissecting the falciform ligament off the linea alba, traversing to the contralateral side, and doing the same on the other side; repairing the hernia, placing the mesh, and closing the rectus sheath. He sometimes does the TAR method and describes it very well.

What am I missing??

Any help or insight will be much appreciated.

NM