tgenia
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Hi Everyone,
I am trying to code a procedure we performed with another group, we assisted with the main procedure and then also removed mesh but code 11008 has a specific range to refer to ( 10180,11004-11006 ) I was also thinking of maybe using cpt 49402 instead, can anyone give me an insight on this and thank you. I attached the operative note below
cpt 54530/80
cpt 49402/59
DATE OF SERVICE: 11/16/2011
SURGEON
MD, FACS
CO-SURGEO, MD
ASSISTANT
UNIVERSITY OF MINNESOTA
PREOPERATIVE DIAGNOSIS
Chronic right groin pain and testicular pain.
POSTOPERATIVE DIAGNOSIS
Chronic right groin pain and testicular pain.
PROCEDURE
1. Explantation of keyhole mesh and plug.
2. Orchiectomy
ESTIMATED BLOOD LOSS
10 cc.
COMPLICATIONS
None.
INDICATIONS
Mr. ---------- is a 47-year-old gentleman who underwent a right inguinal hernia
repair approximately 10 years ago. It was done laparoscopically, and he had a
recurrence. He subsequently had an open repair of that recurrence and
developed chronic pain that had been very bothersome over the last 7 years or
so. We tried multiple modalities to help control his pain, and we were never
really totally successful. We discussed explantation of the mesh, and
possible orchiectomy. He discussed the situation with Dr. as well.
We discussed the potential risks, benefits, and alternatives at great length.
We discussed issues that included, but were not limited to, anesthetic risk,
hemorrhage requiring transfusion, the risk of transfusion, infection, heart
attack, stroke, death, recurrence of the hernia, injury to vessels and nerves
in the region, etc. He had a full understanding of the situation and elected
to proceed. We should also note that we discussed the possibility that
explantation and orchiectomy would not cure his chronic pain. Again, he
elected to proceed.
OPERATIVE FINDINGS
The cord was entrapped within the mesh plug. This was removed, as was the
testicle and cord. There were no complications.
DESCRIPTION OF PROCEDURE
The patient was brought to the operating room, placed in supine position,
prepped and draped in the usual sterile manner. An elliptical incision was
made around the right groin incision, which was somewhat hypertrophic. The
subcutaneous tissue was divided using electrocautery. The external oblique
aponeurosis was identified and incised. We identified the cord structures and
the underlying mesh. The mesh was grasped at the pubic tubercle and the
sutures were cut. It was then bluntly dissected with the use of some
electrocautery away from the underlying musculature. The tails were removed.
The cremasteric muscles were divided. The inferior epigastric artery was
identified and preserved throughout the operation.
With the keyhole mesh removed, the cord structures were well exposed. Dr.
then performed the orchiectomy, and in doing so we removed the mesh
plug. Please see his dictation.
The mesh plug was grasped and retracted. We cut the adhesions of the mesh
circumferentially as we dissected down to the base of the mesh plug. The cord
was then clamped and ligated and divided. The mesh was in good position for
the most part, but inferiorly it had pulled separated from the vessels and
that is where the recurrence had occurred. This was then sutured down to the
inguinal ligament to essentially help prevent a recurrence of the hernia.
Interrupted 0 Nurolon sutures were used. The wound was copiously irrigated.
The spermatic vessels had been suture ligated. There was no bleeding. The
external oblique aponeurosis was closed with a running 3-0 Vicryl. We
injected copious amounts of 0.25% Marcaine. The subcutaneous tissue was
approximated with a running 3-0 Vicryl. The skin was closed with 4-0 Vicryl
subcuticular stitch. Steri-Strips were placed. The wounds were dressed. The
patient was brought to recovery in good condition. There were no
complications. The patient tolerated the procedure well.
Dr, , MD, FACS
I am trying to code a procedure we performed with another group, we assisted with the main procedure and then also removed mesh but code 11008 has a specific range to refer to ( 10180,11004-11006 ) I was also thinking of maybe using cpt 49402 instead, can anyone give me an insight on this and thank you. I attached the operative note below
cpt 54530/80
cpt 49402/59
DATE OF SERVICE: 11/16/2011
SURGEON
MD, FACS
CO-SURGEO, MD
ASSISTANT
UNIVERSITY OF MINNESOTA
PREOPERATIVE DIAGNOSIS
Chronic right groin pain and testicular pain.
POSTOPERATIVE DIAGNOSIS
Chronic right groin pain and testicular pain.
PROCEDURE
1. Explantation of keyhole mesh and plug.
2. Orchiectomy
ESTIMATED BLOOD LOSS
10 cc.
COMPLICATIONS
None.
INDICATIONS
Mr. ---------- is a 47-year-old gentleman who underwent a right inguinal hernia
repair approximately 10 years ago. It was done laparoscopically, and he had a
recurrence. He subsequently had an open repair of that recurrence and
developed chronic pain that had been very bothersome over the last 7 years or
so. We tried multiple modalities to help control his pain, and we were never
really totally successful. We discussed explantation of the mesh, and
possible orchiectomy. He discussed the situation with Dr. as well.
We discussed the potential risks, benefits, and alternatives at great length.
We discussed issues that included, but were not limited to, anesthetic risk,
hemorrhage requiring transfusion, the risk of transfusion, infection, heart
attack, stroke, death, recurrence of the hernia, injury to vessels and nerves
in the region, etc. He had a full understanding of the situation and elected
to proceed. We should also note that we discussed the possibility that
explantation and orchiectomy would not cure his chronic pain. Again, he
elected to proceed.
OPERATIVE FINDINGS
The cord was entrapped within the mesh plug. This was removed, as was the
testicle and cord. There were no complications.
DESCRIPTION OF PROCEDURE
The patient was brought to the operating room, placed in supine position,
prepped and draped in the usual sterile manner. An elliptical incision was
made around the right groin incision, which was somewhat hypertrophic. The
subcutaneous tissue was divided using electrocautery. The external oblique
aponeurosis was identified and incised. We identified the cord structures and
the underlying mesh. The mesh was grasped at the pubic tubercle and the
sutures were cut. It was then bluntly dissected with the use of some
electrocautery away from the underlying musculature. The tails were removed.
The cremasteric muscles were divided. The inferior epigastric artery was
identified and preserved throughout the operation.
With the keyhole mesh removed, the cord structures were well exposed. Dr.
then performed the orchiectomy, and in doing so we removed the mesh
plug. Please see his dictation.
The mesh plug was grasped and retracted. We cut the adhesions of the mesh
circumferentially as we dissected down to the base of the mesh plug. The cord
was then clamped and ligated and divided. The mesh was in good position for
the most part, but inferiorly it had pulled separated from the vessels and
that is where the recurrence had occurred. This was then sutured down to the
inguinal ligament to essentially help prevent a recurrence of the hernia.
Interrupted 0 Nurolon sutures were used. The wound was copiously irrigated.
The spermatic vessels had been suture ligated. There was no bleeding. The
external oblique aponeurosis was closed with a running 3-0 Vicryl. We
injected copious amounts of 0.25% Marcaine. The subcutaneous tissue was
approximated with a running 3-0 Vicryl. The skin was closed with 4-0 Vicryl
subcuticular stitch. Steri-Strips were placed. The wounds were dressed. The
patient was brought to recovery in good condition. There were no
complications. The patient tolerated the procedure well.
Dr, , MD, FACS
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